Provider Demographics
NPI:1275570285
Name:KARAKURUM, ALI S
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:S
Last Name:KARAKURUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE-201
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-331-0200
Mailing Address - Fax:631-331-0202
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:SUITE-201
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-331-0200
Practice Address - Fax:631-331-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185973207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF74233Medicare UPIN
NYA400011971Medicare PIN