Healthcare Provider Details

I. General information

NPI: 1689843088
Provider Name (Legal Business Name): JEFFREY KARSDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NORTHERN BLVD
BALDWIN NY
11510-4936
US

IV. Provider business mailing address

908 NORTHERN BLVD
BALDWIN NY
11510-4936
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-7915
  • Fax:
Mailing address:
  • Phone: 516-223-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number176309
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number176309
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01201770 046
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier52128
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUESHIELD/MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: