1316292469 NPI number — MS. SUSAN G. KLEIN MS EDUCATION

Table of content: MS. SUSAN G. KLEIN MS EDUCATION (NPI 1316292469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316292469 NPI number — MS. SUSAN G. KLEIN MS EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
SUSAN
Provider Middle Name:
G.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS EDUCATION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNSTEIN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316292469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 WILSON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-386-3061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 HIGHWAY 310 SUITE 2
Provider Second Line Business Practice Location Address:
ST LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13617-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-386-2325
Provider Business Practice Location Address Fax Number:
315-386-2203
Provider Enumeration Date:
07/16/2012

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: 174400000X , 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)





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