Provider Demographics
NPI:1548384985
Name:KLEINBERG, JESSICA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:KLEINBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:ST. CYR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 WESTFALL RD
Mailing Address - Street 2:BLDG A SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-244-9720
Mailing Address - Fax:585-244-9995
Practice Address - Street 1:919 WESTFALL RD.
Practice Address - Street 2:BLDG A SUITE 105
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-244-9720
Practice Address - Fax:585-244-9995
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255634-1208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics