Basic Information
Provider Information
NPI: 1629501499
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ISRAEL
FirstName: ANNA-KAROLINE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: M.D., DR. MED.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 ELMWOOD AVENUE
Address2: BOX 626
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852734135
FaxNumber: 5852733637
Practice Location
Address1: 601 ELMWOOD AVE
Address2: BOX 626
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852734580
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2017
LastUpdateDate: 10/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X319429NYY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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