Basic Information
| Provider Information | |||||||||
| NPI: | 1851898282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KARASICK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | HERMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1410 COLTON RD | ||||||||
| Address2: | |||||||||
| City: | GLADWYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190351106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105472686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852753184 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.