Provider Demographics
NPI:1417907171
Name:KLESHCHELSKAYA, VALERIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:
Last Name:KLESHCHELSKAYA
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 1:98 JAMES ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-516-1550
Mailing Address - Fax:732-494-6994
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 313
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-516-1550
Practice Address - Fax:732-494-6994
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08472200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00781667OtherRR MEDICARE
NJ139577ADCOtherMEDICARE ID
NJ0209287Medicaid
NJP00781667OtherRR MEDICARE
CTI20223Medicare UPIN