Provider Demographics
NPI:1033170840
Name:KANTOR, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 KING ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-3600
Mailing Address - Fax:315-393-5802
Practice Address - Street 1:214 KING STREET
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007040174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405630875OtherBLUE CROSS BLUE SHEILD
NY03266786Medicaid
MI382032989OtherCOMMERCIAL
MIKK007040OtherBLUE CROSS BLUE SHEILD
MIP00472866OtherMEDICARE RAIL ROAD
MI3405630875OtherBLUE CARE NETWORK
MI3405630875OtherBLUE CROSS BLUE SHEILD
MI0G46251005Medicare UPIN
MIF37561Medicare UPIN
MI382032989OtherCOMMERCIAL
MIP00472866OtherMEDICARE RAIL ROAD