Provider Demographics
NPI:1124360532
Name:KLUGER, COURTNEY GARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:GARVIN
Last Name:KLUGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102-01 66TH RD
Mailing Address - Street 2:LIJFH - DEPT OF MEDICINE
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-830-4359
Mailing Address - Fax:718-830-1015
Practice Address - Street 1:102-01 66TH RD
Practice Address - Street 2:LIJFH - DEPT OF MEDICINE
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-830-4359
Practice Address - Fax:718-830-1015
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277465207R00000X, 208M00000X
TXS2618207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401742801Medicaid
TX401742802OtherCSHCN