Basic Information
| Provider Information | |||||||||
| NPI: | 1528142387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KARAM | ||||||||
| FirstName: | MAROUN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 S PERRY ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120952316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187361500 | ||||||||
| FaxNumber: | 5187628194 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 S PERRY ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120952316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187361500 | ||||||||
| FaxNumber: | 5187628194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 02/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 157850 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207U00000X | 157850 | NY | N | Allopathic & Osteopathic Physicians | Nuclear Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00997764 | 05 | NY | MEDICAID |