Provider Demographics
NPI:1154473924
Name:KARIMI, LAUREL RITA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:RITA
Last Name:KARIMI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:126 SCHOOL ST
Mailing Address - City:MAHOPAC FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10542-0029
Mailing Address - Country:US
Mailing Address - Phone:845-628-3510
Mailing Address - Fax:
Practice Address - Street 1:126 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MAHOPAC FALLS
Practice Address - State:NY
Practice Address - Zip Code:10542-0029
Practice Address - Country:US
Practice Address - Phone:845-628-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2323541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01453694Medicaid