Provider Demographics
NPI:1164785762
Name:KLIEGMAN, NICOLE J (MS)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:J
Last Name:KLIEGMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SHORE RD
Mailing Address - Street 2:APT. 1DD
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4545
Mailing Address - Country:US
Mailing Address - Phone:516-897-0479
Mailing Address - Fax:
Practice Address - Street 1:522 SHORE RD
Practice Address - Street 2:APT. 1DD
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4545
Practice Address - Country:US
Practice Address - Phone:516-897-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist