Provider Demographics
NPI:1790199412
Name:KAMINSKI, JUSTIN PAUL (DPM)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ESSEX CENTER DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2906
Mailing Address - Country:US
Mailing Address - Phone:978-531-9969
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR STE 208
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2906
Practice Address - Country:US
Practice Address - Phone:978-531-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2456213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery