Provider Demographics
NPI:1134483027
Name:KLEIN, SHOSHANA MIRIAM (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:MIRIAM
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5357
Mailing Address - Country:US
Mailing Address - Phone:845-426-3135
Mailing Address - Fax:
Practice Address - Street 1:119 ROCK HILL RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5357
Practice Address - Country:US
Practice Address - Phone:845-426-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116048021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116048021OtherNEW YORK STATE DEPARTMENT OF EDUCATION