Provider Demographics
NPI:1689607509
Name:LITWAK, KAREN E (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:LITWAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:TRUNKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:REGIONAL ONCOLOGY CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-8200
Mailing Address - Fax:315-464-8206
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:REGIONAL ONCOLOGY CENTER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-8200
Practice Address - Fax:315-464-8206
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02358294Medicaid
NYP00006944Medicare PIN
NY02358294Medicaid