Provider Demographics
NPI:1356335434
Name:KARP, MICHAEL ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIOT
Last Name:KARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:868 CHURCH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-5021
Mailing Address - Country:US
Mailing Address - Phone:631-665-4781
Mailing Address - Fax:631-665-4793
Practice Address - Street 1:868 CHURCH ST STE 2
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-5021
Practice Address - Country:US
Practice Address - Phone:631-665-4781
Practice Address - Fax:631-665-4793
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00655101Medicaid
NY134722OtherLICENSE NUMBER
NYA63094Medicare UPIN
NY52A631Medicare PIN