1740377563 NPI number — MR. BRUCE I. KARP LCSW

Table of content: MR. BRUCE I. KARP LCSW (NPI 1740377563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740377563 NPI number — MR. BRUCE I. KARP LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARP
Provider First Name:
BRUCE
Provider Middle Name:
I.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARP
Provider Other First Name:
YISROEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740377563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
686 EMPIRE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-778-0840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 AVENUE M
Provider Second Line Business Practice Location Address:
SUITE 603
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-778-0840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 1041C0700X , with the licence number:  R-012069 , 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: 334889464 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144892 . This is a "VALUEOPTIONSID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0025783002 . This is a "GHI PROVIDERID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010264901 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144892 . This is a "VALUEOPTIONS ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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