1346235751 NPI number — DR. SHARI LYNN KLIG MD

Table of content: DR. SHARI LYNN KLIG MD (NPI 1346235751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346235751 NPI number — DR. SHARI LYNN KLIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLIG
Provider First Name:
SHARI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346235751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/25/2005
NPI Reactivation Date:
11/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 COLGATE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-433-8530
Provider Business Mailing Address Fax Number:
516-692-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4250 HEMPSTEAD TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-433-8530
Provider Business Practice Location Address Fax Number:
516-692-4240
Provider Enumeration Date:
09/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  175978 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)