1194827436 NPI number — DR. KAREN ALISON NICHOLE MYRIE MD

Table of content: DR. KAREN ALISON NICHOLE MYRIE MD (NPI 1194827436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194827436 NPI number — DR. KAREN ALISON NICHOLE MYRIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYRIE
Provider First Name:
KAREN
Provider Middle Name:
ALISON NICHOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194827436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 OCEAN PKWY
Provider Second Line Business Mailing Address:
UNIT 3M
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11218-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-405-0127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 FIRST AVENUE
Provider Second Line Business Practice Location Address:
3RD FLOOR-RM 325
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-935-1377
Provider Business Practice Location Address Fax Number:
646-935-1362
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  207822 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01888980 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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