Healthcare Provider Details

I. General information

NPI: 1043213440
Provider Name (Legal Business Name): ALEKSEY KAMENETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4766A BEDFORD AVE
BROOKLYN NY
11235-2606
US

IV. Provider business mailing address

312 LINKS DR
OCEANSIDE NY
11572-5623
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-3220
  • Fax: 718-332-5413
Mailing address:
  • Phone: 718-332-3220
  • Fax: 718-332-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number199817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: