Provider Demographics
NPI:1093248932
Name:KLEBANSKY, VALERIE (AGANP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:KLEBANSKY
Suffix:
Gender:F
Credentials:AGANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ADELE AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2144
Mailing Address - Country:US
Mailing Address - Phone:201-784-7433
Mailing Address - Fax:
Practice Address - Street 1:4 ADELE AVE
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-2144
Practice Address - Country:US
Practice Address - Phone:201-784-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00708900363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology