Provider Demographics
NPI:1275563165
Name:KAMENETSKY, ELVIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:
Last Name:KAMENETSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LINKS DR WEST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-536-5515
Mailing Address - Fax:516-536-5515
Practice Address - Street 1:4766A BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2606
Practice Address - Country:US
Practice Address - Phone:718-332-3220
Practice Address - Fax:718-332-5413
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2231572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02242148Medicaid
NY411N11Medicare ID - Type Unspecified
NY02242148Medicaid