Provider Demographics
NPI:1316408123
Name:KARASIEWICZ, MARIOLA DOROTA
Entity Type:Individual
Prefix:
First Name:MARIOLA
Middle Name:DOROTA
Last Name:KARASIEWICZ
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 1:4739 40TH ST APT 5H
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4035
Mailing Address - Country:US
Mailing Address - Phone:646-275-2954
Mailing Address - Fax:
Practice Address - Street 1:4739 40TH ST APT 5H
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-4035
Practice Address - Country:US
Practice Address - Phone:646-275-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343552-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily