Provider Demographics
NPI:1043466725
Name:KLIBANOFF, SARAH EVELYN (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:EVELYN
Last Name:KLIBANOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10112-1501
Mailing Address - Country:US
Mailing Address - Phone:212-765-4444
Mailing Address - Fax:212-765-4459
Practice Address - Street 1:63 W 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112-1501
Practice Address - Country:US
Practice Address - Phone:212-765-4444
Practice Address - Fax:212-765-4459
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 6455 1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist