=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669649497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY KARNOVSKY DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146-32 243RD ST TERRY KARNOVSKY DDS PC
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-527-6200
-----------------------------------------------------
Fax | 718-525-7829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146-32 243RD ST
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-527-6200
-----------------------------------------------------
Fax | 718-525-7829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | MR. TERRY KARNOVSKY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-527-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0286461
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------