Provider Demographics
NPI:1336326263
Name:LAWRENCE KAMINSKY D.P.M.
Entity type:Organization
Organization Name:LAWRENCE KAMINSKY D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-855-4414
Mailing Address - Street 1:24310 MOULTON PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:949-855-4414
Mailing Address - Fax:949-855-1209
Practice Address - Street 1:24310 MOULTON PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3306
Practice Address - Country:US
Practice Address - Phone:949-855-4414
Practice Address - Fax:949-855-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2543332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11375Medicare UPIN
E2543Medicare PIN
4954620001Medicare NSC