Provider Demographics
NPI:1528003019
Name:KLETSMAN, GALINA (DO)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:KLETSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OCEANA DR W APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6660
Mailing Address - Country:US
Mailing Address - Phone:917-817-9634
Mailing Address - Fax:718-946-3230
Practice Address - Street 1:520 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4004
Practice Address - Country:US
Practice Address - Phone:718-333-9070
Practice Address - Fax:718-946-3230
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097501Medicaid
NYH28351Medicare UPIN
NY21V471Medicare ID - Type Unspecified