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NPI Code Detail

MEDICARE: DR. GUNAWAN KARTIKA MD

MEDICARE: DR. GUNAWAN KARTIKA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianMA48381NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225030604
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUNAWAN KARTIKA MD
Provider Business Mailing Address
First Line : 4567 CROSSROADS PARK DR
Second Line : 2ND FLOOR
City : LIVERPOOL
State : NY
Zip : 13088-3589
Country : US
Telephone Number : 315-434-9309
Fax Number : 315-454-0136
Provider Business Practice Location Address
First Line : 355 GRAND ST
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07302-4321
Country : US
Telephone Number : 201-915-2485
Fax Number : 201-915-2377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 09/14/2007

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Directions to “ DR. GUNAWAN KARTIKA MD” Practice Location

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