Provider Demographics
NPI:1518180421
Name:COLTON & KAMINETSKY PA
Entity Type:Organization
Organization Name:COLTON & KAMINETSKY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-994-8595
Mailing Address - Street 1:1905 CLINT MOORE RD
Mailing Address - Street 2:#204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:561-994-8595
Mailing Address - Fax:561-988-0445
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:#204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-994-8595
Practice Address - Fax:561-988-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0065032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2858Medicare ID - Type Unspecified