Provider Demographics
NPI:1386708014
Name:KWAN, MINDY (MD, FACOG)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48263
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:212-319-5535
Mailing Address - Fax:845-782-6914
Practice Address - Street 1:210 CENTRAL PARK S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1428
Practice Address - Country:US
Practice Address - Phone:212-319-5535
Practice Address - Fax:845-782-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215508207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMK081N0710OtherBLUE CROSS BLUE SHIELD
NY5734142OtherCIGNA
NYP2696584OtherOXFORD
NY4C7890OtherHEALTHNET
NYH93031Medicare UPIN
NY4C7890OtherHEALTHNET