Provider Demographics
NPI:1093079931
Name:ROSENBLATT KLEIN, MAYA LOUISA (MA)
Entity Type:Individual
Prefix:MS
First Name:MAYA
Middle Name:LOUISA
Last Name:ROSENBLATT KLEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GATES AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1911
Mailing Address - Country:US
Mailing Address - Phone:347-668-0177
Mailing Address - Fax:
Practice Address - Street 1:141 GATES AVE APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1911
Practice Address - Country:US
Practice Address - Phone:347-668-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457808101171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor