Basic Information
| Provider Information | |||||||||
| NPI: | 1184898595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ODRZYWOLSKI | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17 LANSING STREET | ||||||||
| Address2: | AMMS, PC / CREDENTIALING OFFICE | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152557438 | ||||||||
| FaxNumber: | 3152557099 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 NELSON ST STE 120 | ||||||||
| Address2: | D/B/A NEUROLOGY SERVICES OF AUBURN | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152527434 | ||||||||
| FaxNumber: | 3152538104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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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 | 2084N0400X | 261776 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | NY | MEDICAID |