Provider Demographics
NPI:1033128087
Name:JANKOWSKI, KAREN M
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:JANKOWSKI
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 1:800 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-338-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:130 EMPIRE DRIVE
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-668-6170
Practice Address - Fax:716-656-4074
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NY003876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00245097OtherMEDICARE RAILROAD #
NY000525934004OtherHEALTH NOW BCBS # FOR ED
NY040426003363OtherFIDELIS CARE #
NY6510049OtherIHA #
NY00011283017OtherUNIVERA #
NY000525932005OtherHEALTH NOW BCBS # FOR AU
NY000525934004OtherHEALTH NOW BCBS # FOR ED
NY040426003363OtherFIDELIS CARE #