Provider Demographics
NPI:1568539542
Name:KAMINSKI, CLINTON RICHARD (PA)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:RICHARD
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:CLINT
Other - Middle Name:RICHARD
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,PA-C
Mailing Address - Street 1:10 PETER CIR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1219
Mailing Address - Country:US
Mailing Address - Phone:908-272-0533
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:973-395-7104
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00072200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical