MEDICARE: DR. STEPHEN G KAMINSKY RPA-C

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	363A00000X	Physician Assistant	013218	NY

General Provider Information

NPI Number	:	1285865725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN G KAMINSKY RPA-C

Provider Business Mailing Address
First Line	:	340 HOWELLS RD
Second Line	:	SUITE B
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	631-666-1956
Fax Number	:	631-666-1957

Provider Business Practice Location Address
First Line	:	340 HOWELLS RD
Second Line	:	SUITE B
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	631-666-1956
Fax Number	:	631-666-1957

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

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	12/16/2010

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