Provider Demographics
NPI:1053357152
Name:MINNEROP, CAROL ANN
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:MINNEROP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-861-9012
Mailing Address - Fax:212-369-4034
Practice Address - Street 1:51 E 90TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-861-9012
Practice Address - Fax:212-369-4034
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004668440OtherAETNA US HEALTHCARE
NY00215930Medicaid
0026029OtherAETNA
333301OtherBLUE CROSS BLUE SHIELD
0096733OtherGHI
116588OtherHIP
NY00215930Medicaid