NPIMap

Individual provider Active NPI

Eric Jay Kaminetsky, D.O., PHARM.D.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1093969164
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS018158 Issued in PA
Practice address
2534 S. 18TH Street
Philadelphia, PA 19145
Phone
(215) 463-4363
NPI assigned
Nov 15, 2008
Last updated
Jul 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 65832 GA
Family Medicine Physician 207Q00000X 25MB08797100 NJ
Family Medicine Physician 207Q00000X OS018158 PA Primary

Addresses

Primary practice location

2534 S. 18TH Street
Philadelphia, PA 19145

Mailing address

3175 Route 10 East
Suite 500
Denville, NJ 07834
Phone (973) 891-1213

Other practice location 1

3175 Route 10 East
Suite 500
Denville, NJ 07834
Phone (973) 891-1213

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140623002306 NJ Practitioner - Family Practice 3476724204 Reassigns benefits to 1 organization
I20190718000305 PA Practitioner - Family Practice 3476724204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rowan University School of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

457 Haddonfield Rd
Suite 110
Cherry Hill, NJ 08002-2223
Phone (844) 542-2273

485 Hurffville Crosskeys Rd
Sewell, NJ 08080-9369
Phone (844) 542-2273

80 Tanner St
Haddonfield, NJ 08033-2453
Phone (844) 542-2273

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
65832GAMDFamily Medicine Physician
25MB08797100NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice, P.C. CurrentSince Mar 1, 2015 Accepting new patients
Jefferson University Physicians Family Medicine CurrentSince Jun 6, 2019 Accepting new patients
Kennedy Medical Group Practice, P.C. Family Medicine CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC Family Medicine CurrentSince Mar 1, 2015 Accepting new patients
Kennedy Medical Group Practice P.C. Family Medicine Past Accepting new patients

Locations

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

80 Tanner St
Haddonfield, NJ 08033
Phone (856) 795-1980

485 Hurffville Crosskeys Rd
Sewell, NJ 08080
Phone (856) 557-5555

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1093969164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 ROUTE 10 EAST",
            "address_2": "SUITE 500",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "07834",
            "telephone_number": "973-891-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2534 S. 18TH STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19145",
            "telephone_number": "215-463-4363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3175 Route 10 East",
            "address_2": "Suite 500",
            "address_purpose": "LOCATION",
            "city": "Denville",
            "state": "NJ",
            "postal_code": "07834",
            "country_code": "US",
            "telephone_number": "973-891-1213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAMINETSKY",
        "first_name": "ERIC",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.O., PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-15",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "65832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB08797100",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS018158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.