Basic Information
| Provider Information | |||||||||
| NPI: | 1033128087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANKOWSKI | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CARTER STREET | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853384793 | ||||||||
| FaxNumber: | 5853364845 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 EMPIRE DRIVE | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166686170 | ||||||||
| FaxNumber: | 7166564074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | X | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 003876 | NY | X | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | P00245097 | 01 | NY | MEDICARE RAILROAD # | OTHER | 000525934004 | 01 | NY | HEALTH NOW BCBS # FOR ED | OTHER | 040426003363 | 01 | NY | FIDELIS CARE # | OTHER | 6510049 | 01 | NY | IHA # | OTHER | 00011283017 | 01 | NY | UNIVERA # | OTHER | 000525932005 | 01 | NY | HEALTH NOW BCBS # FOR AU | OTHER |