Provider Demographics
NPI:1265795470
Name:KAMINETZKY, CHANA
Entity type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:KAMINETZKY
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 1:595 CROWN ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5201
Mailing Address - Country:US
Mailing Address - Phone:646-402-4934
Mailing Address - Fax:
Practice Address - Street 1:595 CROWN ST # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5201
Practice Address - Country:US
Practice Address - Phone:646-402-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY991462253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist