Provider Demographics
NPI:1700016649
Name:KLETSMAN, ELAINE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:KLETSMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52B LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3104
Mailing Address - Country:US
Mailing Address - Phone:201-945-9138
Mailing Address - Fax:
Practice Address - Street 1:52B LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3104
Practice Address - Country:US
Practice Address - Phone:201-945-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical