Provider Demographics
NPI:1952378598
Name:KAMINETSKY, JED C (MD)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:C
Last Name:KAMINETSKY
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 1:215 LEXINGTON AVENUE
Mailing Address - Street 2:20TH FLOOR JED C KAMINETSKY MD FACS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-686-5611
Mailing Address - Fax:212-686-8607
Practice Address - Street 1:215 LEXINGTON AVENUE
Practice Address - Street 2:20TH FLOOR JED C KAMINETSKY MD FACS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-686-9015
Practice Address - Fax:212-686-8607
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY162871208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01172027Medicaid
NY01172027Medicaid
E44778Medicare UPIN
81F5210Medicare ID - Type Unspecified