Provider Demographics
NPI:1578106480
Name:KARNI KISSIL PH.D LLC
Entity Type:Organization
Organization Name:KARNI KISSIL PH.D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-225-4124
Mailing Address - Street 1:507 COCOPLUM DR S
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8335
Mailing Address - Country:US
Mailing Address - Phone:561-225-4124
Mailing Address - Fax:
Practice Address - Street 1:641 UNIVERSITY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2793
Practice Address - Country:US
Practice Address - Phone:561-225-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)