Provider Demographics
NPI:1952817629
Name:KARBOSKI, MARIE S
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:S
Last Name:KARBOSKI
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 1:3018 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2713
Mailing Address - Country:US
Mailing Address - Phone:315-668-0422
Mailing Address - Fax:315-668-0424
Practice Address - Street 1:3018 EAST AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-2713
Practice Address - Country:US
Practice Address - Phone:315-668-0422
Practice Address - Fax:315-668-0424
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009884-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician