Provider Demographics
NPI:1689620817
Name:KRNJAICH, KAREN
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:KRNJAICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KRNJAICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD/CDN
Mailing Address - Street 1:11 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9457
Mailing Address - Country:US
Mailing Address - Phone:716-683-8058
Mailing Address - Fax:
Practice Address - Street 1:4105 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3045
Practice Address - Country:US
Practice Address - Phone:716-677-0250
Practice Address - Fax:716-677-0253
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered