Provider Demographics
NPI:1144581026
Name:CARITA, KAREN ANN
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:CARITA
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 1:73 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4044
Mailing Address - Country:US
Mailing Address - Phone:631-627-3041
Mailing Address - Fax:
Practice Address - Street 1:73 APPLE LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4044
Practice Address - Country:US
Practice Address - Phone:631-627-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1740709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist