Provider Demographics
NPI:1164523577
Name:FALLIS, KAREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:FALLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COVERT AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3215
Mailing Address - Country:US
Mailing Address - Phone:516-327-6900
Mailing Address - Fax:516-616-1700
Practice Address - Street 1:5 COVERT AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3215
Practice Address - Country:US
Practice Address - Phone:516-327-6900
Practice Address - Fax:516-616-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131055207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00465449Medicaid
27A913Medicare ID - Type Unspecified
NY00465449Medicaid