Healthcare Provider Details

I. General information

NPI: 1255735437
Provider Name (Legal Business Name): JOMARI KAMINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 VALLEY RD
STIRLING NJ
07980-1523
US

IV. Provider business mailing address

1071 VALLEY RD
STIRLING NJ
07980-1523
US

V. Phone/Fax

Practice location:
  • Phone: 908-604-4500
  • Fax: 908-604-4505
Mailing address:
  • Phone: 908-604-4500
  • Fax: 908-604-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-9587
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: