Provider Demographics
NPI:1629287768
Name:KLIOT OBSETRICTIS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:KLIOT OBSETRICTIS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:KLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-693-1011
Mailing Address - Street 1:225 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4509
Mailing Address - Country:US
Mailing Address - Phone:718-639-1011
Mailing Address - Fax:718-282-7298
Practice Address - Street 1:225 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4509
Practice Address - Country:US
Practice Address - Phone:718-639-1011
Practice Address - Fax:718-282-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG36392Medicare UPIN