1386744753 NPI number — KAREN A POLENSKY MS, RD/LDN, CDE

Table of content: KAREN A POLENSKY MS, RD/LDN, CDE (NPI 1386744753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386744753 NPI number — KAREN A POLENSKY MS, RD/LDN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLENSKY
Provider First Name:
KAREN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD/LDN, CDE
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:
1386744753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 PINE CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-9668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-609-3537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 NORLAND AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-217-6820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

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: 133V00000X , with the licence number:  DN003369 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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