Basic Information
Provider Information
NPI: 1528070596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAFT
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RPA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GRIFFIN
OtherFirstName: KAREN
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 5010 STATE HIGHWAY 30
Address2: SUITE 205
City: AMSTERDAM
State: NY
PostalCode: 120107532
CountryCode: US
TelephoneNumber: 5188422663
FaxNumber: 5188424861
Practice Location
Address1: 5010 STATE HIGHWAY 30
Address2: SUITE 205
City: AMSTERDAM
State: NY
PostalCode: 120107532
CountryCode: US
TelephoneNumber: 5188422663
FaxNumber: 5188424861
Other Information
ProviderEnumerationDate: 08/11/2006
LastUpdateDate: 05/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X011351NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

ID Information
IDTypeStateIssuerDescription
39056101NYMVPOTHER
J40007367901NYMEDICAREOTHER
00041240200101NYBS NENYOTHER
0155815805NY MEDICAID


Home