Provider Demographics
NPI:1750686986
Name:KAMINENI, KRISHNESHWAR
Entity Type:Individual
Prefix:
First Name:KRISHNESHWAR
Middle Name:
Last Name:KAMINENI
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 1:3116 68TH ST
Mailing Address - Street 2:APT 3D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1236
Mailing Address - Country:US
Mailing Address - Phone:646-998-8128
Mailing Address - Fax:646-998-8038
Practice Address - Street 1:501 5TH AVE
Practice Address - Street 2:SUITE 1204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6107
Practice Address - Country:US
Practice Address - Phone:646-998-8128
Practice Address - Fax:646-998-8038
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist