Healthcare Provider Details

I. General information

NPI: 1770696916
Provider Name (Legal Business Name): KAREN M PEREKALSKY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2384 BROADWAY
NEW YORK NY
10024-1703
US

IV. Provider business mailing address

2384 BROADWAY
NEW YORK NY
10024-1703
US

V. Phone/Fax

Practice location:
  • Phone: 212-724-0850
  • Fax:
Mailing address:
  • Phone: 212-724-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV007048
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007048
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number171657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: