Provider Demographics
NPI:1407067986
Name:MIDDLETOWN NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:MIDDLETOWN NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-342-6464
Mailing Address - Street 1:225 DOLSON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-6464
Mailing Address - Fax:845-477-3565
Practice Address - Street 1:225 DOLSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-342-6464
Practice Address - Fax:845-477-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238014207RN0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684628Medicaid
NY133AE1Medicare ID - Type Unspecified
NY02684628Medicaid