Healthcare Provider Details

I. General information

NPI: 1689789943
Provider Name (Legal Business Name): KAREN ELIZABETH GORENFLO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 S HAMILTON ST SUITE 109
PAINTED POST NY
14870-9705
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-2089
  • Fax: 607-936-8176
Mailing address:
  • Phone: 607-271-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF334748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: