Basic Information
| Provider Information | |||||||||
| NPI: | 1205832383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KVILEKVAL | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312468289 | ||||||||
| FaxNumber: | 6312468294 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117334068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312468289 | ||||||||
| FaxNumber: | 6312468294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/16/2006 | ||||||||
| NPIReactivationDate: | 03/27/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 162761-1 | NY | Y | Other Service Providers | Specialist |
No ID Information.