Healthcare Provider Details

I. General information

NPI: 1063775229
Provider Name (Legal Business Name): MS. KAREN MARIE MASKELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST
BATAVIA NY
14020-1807
US

IV. Provider business mailing address

210 S MAIN ST
BATAVIA NY
14020-1807
US

V. Phone/Fax

Practice location:
  • Phone: 585-356-3617
  • Fax:
Mailing address:
  • Phone: 585-356-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: