Provider Demographics
NPI:1033268453
Name:KLEINERMAN, LAURA (MS RN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:KLEINERMAN
Suffix:
Gender:F
Credentials:MS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WEST 86TH STREET
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4029
Mailing Address - Country:US
Mailing Address - Phone:212-874-2417
Mailing Address - Fax:
Practice Address - Street 1:156 WEST 86TH STREET
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4029
Practice Address - Country:US
Practice Address - Phone:212-874-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276317364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR00741Medicare ID - Type Unspecified