Provider Demographics
NPI:1043288582
Name:KOWALENKO, KAREN F (DO LLC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:F
Last Name:KOWALENKO
Suffix:
Gender:F
Credentials:DO LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7165
Mailing Address - Country:US
Mailing Address - Phone:732-563-9656
Mailing Address - Fax:
Practice Address - Street 1:6 ASPEN CT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7165
Practice Address - Country:US
Practice Address - Phone:732-563-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB55235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080124312Medicaid
NJ053553Medicare ID - Type Unspecified
NJ080124312Medicaid