Healthcare Provider Details

I. General information

NPI: 1912432113
Provider Name (Legal Business Name): HEATHER KAMINSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/22/2023
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RIVER RD
ROCHESTER NY
14623-1212
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278984
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2808
  • Fax:
Mailing address:
  • Phone: 585-275-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number317452
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number317452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: