Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 255604 | NY |
Y | 207Q00000X | Family Doctor | 255604 | NY |
NPI | 1518151927 |
---|---|
Provider Name | Karissa Scarabino |
First Address | Ballston Spa, NY 12020-3603 |
Second Address | Ballston Spa, NY 12020-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 08/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03190503 | (05) | NY |