Provider Demographics
NPI:1063506442
Name:KAMINSKY, NEIL I (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:I
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:PMG AT 8300 CONSTITUTION POB
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-559-6400
Practice Address - Fax:505-559-6488
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-24
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Provider Licenses
StateLicense IDTaxonomies
NM6714207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14480Medicaid
NM14480Medicaid
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