Provider Demographics
NPI:1174506158
Name:FERDINAND, KAREN S (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:FERDINAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BLDG. 14
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-447-8300
Mailing Address - Fax:631-447-8872
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BLDG. 14
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-447-8300
Practice Address - Fax:631-447-8872
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002595363L00000X
NYF303346-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT025950OtherCONNECTICARE
CT400002595CT02OtherANTHEM
CT400002595CT02OtherANTHEM
P97280Medicare UPIN
CT025950OtherCONNECTICARE