Healthcare Provider Details

I. General information

NPI: 1932138443
Provider Name (Legal Business Name): ANDREW ADAM KAMINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 NASSAU AVE
BROOKLYN NY
11222-3543
US

IV. Provider business mailing address

194 NASSAU AVE
BROOKLYN NY
11222-3543
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-5775
  • Fax: 718-383-7154
Mailing address:
  • Phone: 718-389-5775
  • Fax: 718-383-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number155454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: