MEDICARE: DR. ELVIRA KAMENETSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	223157	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275563165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELVIRA KAMENETSKY M.D.

Provider Business Mailing Address
First Line	:	312 LINKS DR WEST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572
Country	:	US
Telephone Number	:	516-536-5515
Fax Number	:	516-536-5515

Provider Business Practice Location Address
First Line	:	4766A BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2606
Country	:	US
Telephone Number	:	718-332-3220
Fax Number	:	718-332-5413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/05/2021

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