Provider Demographics
NPI:1710922646
Name:MEDNIK, KARINE M (MD)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:M
Last Name:MEDNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5016
Mailing Address - Country:US
Mailing Address - Phone:347-254-8755
Mailing Address - Fax:
Practice Address - Street 1:8710 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7704
Practice Address - Country:US
Practice Address - Phone:347-254-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300392Medicaid
NY112990594OtherGROUP TAX ID NUMBER
NYH77922Medicare UPIN
NY02300392Medicaid