Healthcare Provider Details

I. General information

NPI: 1154735496
Provider Name (Legal Business Name): MICHAEL CHARLES KAMINSKY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PARK AVE
PLAINFIELD NJ
07060-3228
US

IV. Provider business mailing address

PO BOX 95000 LB# 7685
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 908-224-1793
  • Fax: 908-755-9204
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00334500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: