Basic Information
| Provider Information | |||||||||
| NPI: | 1811401128 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PK MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 321 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117430321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006552656 | ||||||||
| FaxNumber: | 4128227411 | ||||||||
| Practice Location | |||||||||
| Address1: | EXCEL AT WOODBURY | ||||||||
| Address2: | 8533 JERICHO TURNPILE | ||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117971804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166924100 | ||||||||
| FaxNumber: | 5166927571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | KARAMANLAKIS | ||||||||
| AuthorizedOfficialFirstName: | PETROS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8006552656 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.