Basic Information
| Provider Information | |||||||||
| NPI: | 1164730339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMINSKA | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOTT | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8750 TRANSIT RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140512610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166361470 | ||||||||
| FaxNumber: | 8888862563 | ||||||||
| Practice Location | |||||||||
| Address1: | 8750 TRANSIT RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140512610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166361470 | ||||||||
| FaxNumber: | 8888862563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2010 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 014158 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 014158 | 01 | NY | NYS PROFESSIONAL LICENSE | OTHER |