Provider Demographics
NPI:1265898662
Name:MINLIONICA, ROBERT (DC, ATC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MINLIONICA
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 KRAMER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4226
Mailing Address - Country:US
Mailing Address - Phone:718-702-3659
Mailing Address - Fax:
Practice Address - Street 1:2950 HYLAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4056
Practice Address - Country:US
Practice Address - Phone:718-874-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38MC00788700111N00000X
NY0029082255A2300X
NY25MT002097002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer