Healthcare Provider Details

I. General information

NPI: 1023084696
Provider Name (Legal Business Name): KAREN M WESSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTHERN BLVD SUITE 120
GREAT NECK NY
11021-5317
US

IV. Provider business mailing address

1010 NORTHERN BLVD SUITE 120
GREAT NECK NY
11021-5317
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-0050
  • Fax: 516-829-0052
Mailing address:
  • Phone: 516-829-0050
  • Fax: 516-829-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number223800
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number223800
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: