Provider Demographics
NPI:1821459090
Name:BLANK, KAREN (ACE CPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:ACE CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-1129
Mailing Address - Country:US
Mailing Address - Phone:585-507-9326
Mailing Address - Fax:
Practice Address - Street 1:810 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9198
Practice Address - Country:US
Practice Address - Phone:585-507-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty