Provider Demographics
NPI:1962582262
Name:MICHELENA, KAREN K (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:K
Last Name:MICHELENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5344 SACANDAGA RD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-2422
Mailing Address - Country:US
Mailing Address - Phone:518-882-6955
Mailing Address - Fax:518-886-5880
Practice Address - Street 1:5344 SACANDAGA RD
Practice Address - Street 2:
Practice Address - City:GALWAY
Practice Address - State:NY
Practice Address - Zip Code:12074-2422
Practice Address - Country:US
Practice Address - Phone:518-882-6955
Practice Address - Fax:518-886-5880
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY233388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7210Medicare PIN
NYI32979Medicare UPIN