Provider Demographics
NPI:1154414530
Name:KASMINOFF, JUNE G (DPM)
Entity type:Individual
Prefix:DR
First Name:JUNE
Middle Name:G
Last Name:KASMINOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 OLD BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1219
Mailing Address - Country:US
Mailing Address - Phone:516-586-4055
Mailing Address - Fax:516-777-4565
Practice Address - Street 1:666 OLD BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1219
Practice Address - Country:US
Practice Address - Phone:516-586-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004947213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113298176OtherTAX ID
NY06149238Medicaid
NYP60351OtherBC/BS
NYU39908Medicare UPIN
NY06149238Medicaid