Healthcare Provider Details

I. General information

NPI: 1528048444
Provider Name (Legal Business Name): KARA LYNN GARDNER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KARA GARDNER YOUNG MS

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 12TH ST NR925, GENETICS
NEW YORK NY
10011-8202
US

IV. Provider business mailing address

22 RIVER TER
NEW YORK NY
10282-1149
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-7692
  • Fax: 212-604-3899
Mailing address:
  • Phone: 212-608-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2002119
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: