Provider Demographics
NPI:1497439145
Name:KLOKOV, SERGEI (MD)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:
Last Name:KLOKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DUBOIS STREET
Mailing Address - Street 2:MONTEFIORE ST. LUKES CORNWALL
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:MONTEFIORE ST. LUKES CORNWALL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-458-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2024-01-18
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-01-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program