1720274558 NPI number — LEE ANN M KLAUSNER MD PLLC

Table of content: (NPI 1720274558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720274558 NPI number — LEE ANN M KLAUSNER MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE ANN M KLAUSNER MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720274558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 E 79TH ST
Provider Second Line Business Mailing Address:
SUITE 15A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10075-0432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-288-1011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 E 78TH ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10075-0312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-288-1011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLAUSNER
Authorized Official First Name:
LEE ANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
212-288-1011

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  215036 , 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)

  • Identifier: 9755825 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3552441 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N92561 . This is a "HEALTHNET" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200581454 . This is a "UNITED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8675495 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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