1104118769 NPI number — SUSAN A KAMINSKI, MD,PC

Table of content: (NPI 1104118769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104118769 NPI number — SUSAN A KAMINSKI, MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN A KAMINSKI, MD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1104118769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 TUCKAHOE RD APT 1K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10710-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-793-2002
Provider Business Mailing Address Fax Number:
914-793-2757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 TUCKAHOE RD APT 1K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10710-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-793-2002
Provider Business Practice Location Address Fax Number:
914-793-2757
Provider Enumeration Date:
05/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KAMINSKI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
914-793-2002

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  180580 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01220731 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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