June G Kasminoff, DPM

Individual provider Active NPI Primary Podiatric Medicine Podiatrist · Old Bethpage, NY

NPI 1154414530 · NPPES record last updated Nov 30, 2011

Key facts

NPI
1154414530
Entity type
Individual (NPI type 1)
Primary specialty
Primary Podiatric Medicine Podiatrist 213EP1101X
License
N004947 (NY)
Practice address
666 Old Bethpage Rd
Old Bethpage, NY 11804-1219
Phone
(516) 586-4055
NPI assigned
Sep 30, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
N004947NYMDPrimary Podiatric Medicine Podiatrist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X N004947 NY Yes

Addresses

Primary practice location

666 Old Bethpage Rd
Old Bethpage, NY 11804-1219

Mailing address

666 Old Bethpage Rd
Old Bethpage, NY 11804-1219
Phone (516) 586-4055

Other identifiers

IdentifierTypeStateIssuer
113298176OtherNYTAX ID
06149238MedicaidNY
P60351OtherNYBC/BS

Other providers in Old Bethpage, NY

All providers in Old Bethpage, NY · Primary Podiatric Medicine Podiatrist in New York

Sources for this page

Verify at the official NPI Registry.