Healthcare Provider Details

I. General information

NPI: 1023319829
Provider Name (Legal Business Name): KAREN BREGOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 PROSPECT PL
PEARL RIVER NY
10965-2529
US

IV. Provider business mailing address

167 PROSPECT PL
PEARL RIVER NY
10965-2529
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone: 845-735-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: