1376893750 NPI number — MS. KAREN ELIZABETH CHAMBERLAIN M.S.,P.T.

Table of content: MS. KAREN ELIZABETH CHAMBERLAIN M.S.,P.T. (NPI 1376893750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376893750 NPI number — MS. KAREN ELIZABETH CHAMBERLAIN M.S.,P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMBERLAIN
Provider First Name:
KAREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,P.T.
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:
1376893750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
576 BROADHOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-359-5859
Provider Business Mailing Address Fax Number:
631-396-0865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 OLD FARMINGDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-376-7032
Provider Business Practice Location Address Fax Number:
631-376-7099
Provider Enumeration Date:
09/13/2012

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: 225100000X , with the licence number:  018849 , 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)





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