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General NPI Number Information
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NPI Number | 1114011780
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Entity Type | Organization
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Legal Business Name | GANESH KARIM MD
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 97-30 57TH AVE. SUITE 1K
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-271-3344
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Fax | 718-760-4851
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Provider Business Mailing Address
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Address Line | 97-30 57TH AVE. SUITE 1K
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-271-3344
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Fax | 718-760-4851
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. LALITHA GANESH
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Credential | MD
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Telephone | 718-271-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 155042
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License Number State | NY
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