Provider Demographics
NPI:1477512556
Name:KLESARIS, MARY-LAURA (MD)
Entity Type:Individual
Prefix:
First Name:MARY-LAURA
Middle Name:
Last Name:KLESARIS
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 1:103 BOND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2247
Mailing Address - Country:US
Mailing Address - Phone:718-797-0789
Mailing Address - Fax:718-797-0689
Practice Address - Street 1:103 BOND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2247
Practice Address - Country:US
Practice Address - Phone:718-797-0789
Practice Address - Fax:718-797-0689
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI00174Medicare UPIN
NY114AH1Medicare PIN