Individual
IRWIN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
47 E 77TH ST STE 216, NEW YORK, NY 10075-1730
(212) 689-7199
Mailing address
4 SADORE LN APT 7X, YONKERS, NY 10710-4757
(914) 393-5715
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051836
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051836
LICENSE
NY
Enumeration date
08/15/2006
Last updated
03/17/2018
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