Provider Demographics
NPI:1518917715
Name:DECROSTA, KAREN E (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DECROSTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 HOPEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1335
Mailing Address - Country:US
Mailing Address - Phone:845-896-5380
Mailing Address - Fax:845-896-5161
Practice Address - Street 1:1222 HOPEWELL AVE
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1335
Practice Address - Country:US
Practice Address - Phone:845-896-5380
Practice Address - Fax:845-896-5161
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0090681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
350880OtherMVP
10082139OtherCDPHP
7469663OtherAETNA
Q00F81OtherBLUE CROSS BLUE SHIELD
1375944OtherUNITEDHEALTHCARE
000000079903OtherGHI
NYQ00F8QBII1OtherMEDICARE UNSPECIFIED
6935108OtherCIGNA
804779OtherMPN
NYQ00F81Medicare PIN