Provider Demographics
NPI:1013793041
Name:ANSELMO, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ANSELMO
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 1:1651 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5526
Mailing Address - Country:US
Mailing Address - Phone:516-781-2152
Mailing Address - Fax:
Practice Address - Street 1:1651 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:N BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5526
Practice Address - Country:US
Practice Address - Phone:516-781-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist