Provider Demographics
NPI:1124582135
Name:CLAROS ARGUETA, KAREN L
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:CLAROS ARGUETA
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 1:12 CHAPEL HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1920
Mailing Address - Country:US
Mailing Address - Phone:631-747-5505
Mailing Address - Fax:
Practice Address - Street 1:12 CHAPEL HILL DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1920
Practice Address - Country:US
Practice Address - Phone:631-747-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334523164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFB25475TMedicaid