Provider Demographics
NPI:1578841292
Name:KAMINSKI, KRYSTAL M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:M
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KRYSTAL
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2619 CULVER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1738
Mailing Address - Country:US
Mailing Address - Phone:585-342-2410
Mailing Address - Fax:
Practice Address - Street 1:2619 CULVER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1738
Practice Address - Country:US
Practice Address - Phone:585-342-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015014363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400054811Medicare PIN