Provider Demographics
NPI:1003178575
Name:REESE, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-3622
Mailing Address - Country:US
Mailing Address - Phone:315-717-7442
Mailing Address - Fax:315-985-0062
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-3622
Practice Address - Country:US
Practice Address - Phone:315-717-7442
Practice Address - Fax:315-985-0062
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist