Provider Demographics
NPI:1104369909
Name:KLEIN, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-230-5161
Mailing Address - Fax:845-278-4320
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:STE 300
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-230-5161
Practice Address - Fax:845-278-4320
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7516363LF0000X
NYF340464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily