| Street | 29 Jerusalem Ave | ||
| City/Town | Levittown | ||
| State/Province/Region | New York | ||
| Zip/Postal Code | 11756 | ||
| Phone Number | (516) 579-5858 | ||
| Country | United States |
| Full Name | Karli Effertz MD | ||
| Gender | female | ||
| Birthday | 1991-01-10 | ||
| Social Security Number | 251-99-1976 |
| Credit card brand | JCB | ||
| Credit card number | 3545005816156876 | ||
| Expire | 2029/10 | ||
| CVV | 401 |