Provider Demographics
NPI:1598318594
Name:KAZANJIAN, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KAZANJIAN
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 1:22 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3718
Mailing Address - Country:US
Mailing Address - Phone:845-492-1963
Mailing Address - Fax:
Practice Address - Street 1:22 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3718
Practice Address - Country:US
Practice Address - Phone:845-492-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care