Provider Demographics
NPI:1558695924
Name:MARACINA, KAREN A
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:MARACINA
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 1:601 PORTION RD STE 14
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4584
Mailing Address - Country:US
Mailing Address - Phone:631-648-9488
Mailing Address - Fax:631-648-9487
Practice Address - Street 1:601 PORTION RD STE 14
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4584
Practice Address - Country:US
Practice Address - Phone:631-648-9488
Practice Address - Fax:631-648-9487
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-004450156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician