Provider Demographics
NPI:1912903006
Name:KAMINENI, SAMBASIVA (MD)
Entity Type:Individual
Prefix:
First Name:SAMBASIVA
Middle Name:
Last Name:KAMINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2602
Mailing Address - Country:US
Mailing Address - Phone:516-484-2326
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2473
Practice Address - Fax:718-275-2673
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-06-15
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NY214050208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162454OtherELDERPLAN
NY3C3295OtherHEALTHNET
NYP2214925OtherOXFORD
NY214050-A53OtherHEALTHFIRST
NY2323323003OtherCIGNA
NY02081872Medicaid
NY0199264OtherGHI
NY0007447135OtherAETNA
NY34141POtherHIP
NY06440GMedicare ID - Type Unspecified
NY2323323003OtherCIGNA