Provider Demographics
NPI:1417019118
Name:KLOSKO, JANET S (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:KLOSKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 OHAYO MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-2516
Mailing Address - Country:US
Mailing Address - Phone:845-657-9809
Mailing Address - Fax:845-657-6173
Practice Address - Street 1:11 MIDDLE NECK RD
Practice Address - Street 2:STE 312
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2301
Practice Address - Country:US
Practice Address - Phone:516-466-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV94751Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST