Provider Demographics
NPI:1225479454
Name:KLIGERMAN, VICKI (RD)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:KLIGERMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 HUDSON MANOR TER
Mailing Address - Street 2:APT. 5HW
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1126
Mailing Address - Country:US
Mailing Address - Phone:917-806-1068
Mailing Address - Fax:
Practice Address - Street 1:308 WILLOW AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3808
Practice Address - Country:US
Practice Address - Phone:201-418-1000
Practice Address - Fax:201-418-1444
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered