Provider Demographics
NPI:1578755146
Name:KARPP, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KARPP
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:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12775-0616
Mailing Address - Country:US
Mailing Address - Phone:845-796-8796
Mailing Address - Fax:
Practice Address - Street 1:48 LAKE SIDE DRIVE
Practice Address - Street 2:
Practice Address - City:LOCH SHELDRAKE
Practice Address - State:NY
Practice Address - Zip Code:12759
Practice Address - Country:US
Practice Address - Phone:845-796-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272710-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02886937OtherMEDICAID PROVIDER ID #