Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004947 | NY |
NPI | 1154414530 |
---|---|
Provider Name | Dr. June G Kasminoff |
First Address | Old Bethpage, NY 11804-1219 |
Second Address | Old Bethpage, NY 11804-1219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 30/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06149238 | (05) | NY |
113298176 | TAX ID (01) | NY |
P60351 | BC/BS (01) | NY |
U39908 | (02) | NY |