Provider Demographics
NPI:1073660064
Name:KAMVAKIS, DEAN STEVEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:STEVEN
Last Name:KAMVAKIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TRENT LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1238
Mailing Address - Country:US
Mailing Address - Phone:516-686-7776
Mailing Address - Fax:516-686-1219
Practice Address - Street 1:NORTHERN BLVD.
Practice Address - Street 2:NYIT ATHLETICS
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-8000
Practice Address - Country:US
Practice Address - Phone:516-686-7776
Practice Address - Fax:516-686-1219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer