Provider Demographics
NPI:1477690840
Name:ERIC G. KLAUSNER, MD, PLLC
Entity Type:Organization
Organization Name:ERIC G. KLAUSNER, MD, PLLC
Other - Org Name:NATHAN LITTAUER HOSPITAL AND NH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:KLAUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-883-8620
Mailing Address - Street 1:STATE HIGHWAY 30
Mailing Address - Street 2:PERTH PRIMARY CARE CENTER
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-883-8620
Mailing Address - Fax:
Practice Address - Street 1:PERTH PRIMARY CARE CENTER STATE HIGHWAY 30
Practice Address - Street 2:STATE HIGHWAY 30
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-883-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1518982982OtherINDIVIDUAL NPI
NYF333567OtherTHERESA KLAUSNER
NY01279161Medicaid
NY180976OtherERIC KLAUSNER LICENSE
NY1265587117OtherTHERESA KLAUSNER NPI
NYF21610Medicare UPIN
NY180976OtherERIC KLAUSNER LICENSE
NY01279161Medicaid