Healthcare Provider Details

I. General information

NPI: 1992895320
Provider Name (Legal Business Name): GREGORY KARCNIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COATES DR SUITE 8
GOSHEN NY
10924-6764
US

IV. Provider business mailing address

3 COATES DR SUITE 8
GOSHEN NY
10924-6764
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-0999
  • Fax: 845-294-8921
Mailing address:
  • Phone: 845-291-0999
  • Fax: 845-294-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number172774-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: