Provider Demographics
NPI:1659557387
Name:KAMINKER-SLAVIN, FAGY ESTHER (PA - C)
Entity Type:Individual
Prefix:MRS
First Name:FAGY
Middle Name:ESTHER
Last Name:KAMINKER-SLAVIN
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:FAGY
Other - Middle Name:ESTHER
Other - Last Name:KAMINKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 EMPIRE BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 EMPIRE BLVD APT 4E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5387
Practice Address - Country:US
Practice Address - Phone:718-774-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant