Provider Demographics
NPI:1508836495
Name:CERINETTI, KAREN C (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:CERINETTI
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 1:4400 VESTAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13902-1625
Mailing Address - Country:US
Mailing Address - Phone:607-777-2221
Mailing Address - Fax:570-777-5280
Practice Address - Street 1:4400 VESTAL PARKWAY
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902
Practice Address - Country:US
Practice Address - Phone:607-777-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAS002121B363L00000X
NY330786-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500018992OtherRR MEDICARE PIN
PAGU039851OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA844296N86Medicare UPIN
PACG1637Medicare PIN
PA844296Medicare ID - Type Unspecified
PA500023011Medicare PIN