Provider Demographics
NPI:1558781567
Name:KAMINETZKY, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:KAMINETZKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMPUTER RD STE E25
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1737
Mailing Address - Country:US
Mailing Address - Phone:215-366-1160
Mailing Address - Fax:215-366-1141
Practice Address - Street 1:2300 COMPUTER RD STE E25
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-366-1160
Practice Address - Fax:215-366-1141
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206923207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology