Provider Demographics
NPI:1164582516
Name:HERMANN, CAROL KAMINSKE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:KAMINSKE
Last Name:HERMANN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7559 263RD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-8902
Mailing Address - Fax:718-470-9784
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-8902
Practice Address - Fax:718-962-7712
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1507462084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04043Medicare UPIN