1912903006 NPI number — SAMBASIVA KAMINENI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912903006 NPI number — SAMBASIVA KAMINENI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KAMINENI

Provider First Name:

SAMBASIVA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1912903006

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/15/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

03/16/2006

NPI Reactivation Date:

03/23/2006

Provider First Line Business Mailing Address:

26 CLUB DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ROSLYN HEIGHTS

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11577-2602

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

516-484-2326

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

7901 BROADWAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ELMHURST

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11373-1329

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

718-334-2473

Provider Business Practice Location Address Fax Number:

718-275-2673

Provider Enumeration Date:

06/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  214050 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2086S0129X , with the licence number: 214050 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 162454 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3C3295 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P2214925 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 214050-A53 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2323323003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02081872 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 0199264 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0007447135 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 34141P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".