Provider Demographics
NPI:1043216906
Name:KLEIN, ELEANOR CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:CHRISTINE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:E
Other - Middle Name:CHRISTINE
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:85 SOUTH WEST STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:2805 CINCINNATUS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATUS
Practice Address - State:NY
Practice Address - Zip Code:13040-9669
Practice Address - Country:US
Practice Address - Phone:607-863-4126
Practice Address - Fax:607-863-3455
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5277205163W00000X
NYF330945-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS58346Medicare UPIN
NYCC3188Medicare UPIN