Provider Demographics
NPI:1588684138
Name:KAMINSKY, JACK STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:STUART
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3705
Mailing Address - Country:US
Mailing Address - Phone:212-355-2290
Mailing Address - Fax:212-355-2379
Practice Address - Street 1:209 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3705
Practice Address - Country:US
Practice Address - Phone:212-355-2290
Practice Address - Fax:212-355-2379
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0367461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice