Provider Demographics
NPI:1831190909
Name:LATZKO, KAREN M (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:LATZKO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 STANHOPE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5757
Mailing Address - Country:US
Mailing Address - Phone:609-924-6487
Mailing Address - Fax:609-921-7020
Practice Address - Street 1:134 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-924-6487
Practice Address - Fax:609-921-7020
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06857800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8281009Medicaid
NJG78301Medicare UPIN
NJ8281009Medicaid