Provider Demographics
NPI:1023120375
Name:CAMARINOS, NICHOLAS G (DPM, FACFS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:CAMARINOS
Suffix:
Gender:M
Credentials:DPM, FACFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2716
Mailing Address - Country:US
Mailing Address - Phone:718-721-0441
Mailing Address - Fax:718-278-5188
Practice Address - Street 1:2806 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2716
Practice Address - Country:US
Practice Address - Phone:718-721-0441
Practice Address - Fax:718-278-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002266213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01695367Medicaid
NY51220Medicare PIN
NY01695367Medicaid
NY441480414Medicare PIN