Provider Demographics
NPI:1457624926
Name:RENICK, KAREN (HAD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RENICK
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3317
Mailing Address - Country:US
Mailing Address - Phone:516-763-3277
Mailing Address - Fax:516-431-7490
Practice Address - Street 1:108 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3317
Practice Address - Country:US
Practice Address - Phone:516-763-3277
Practice Address - Fax:516-431-7490
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000010727237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist