Provider Demographics
NPI:1487718631
Name:MINKOFF, ALAN RICHARD (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:RICHARD
Last Name:MINKOFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6806 BAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5524
Mailing Address - Country:US
Mailing Address - Phone:718-236-4352
Mailing Address - Fax:718-837-0783
Practice Address - Street 1:6806 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5524
Practice Address - Country:US
Practice Address - Phone:718-236-4352
Practice Address - Fax:718-837-0783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003471-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0247540001Medicare NSC
T81473Medicare UPIN
NYC27661Medicare PIN