Provider Demographics
NPI:1730500463
Name:KLEINBERG, CHAYA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHAYA
Middle Name:
Last Name:KLEINBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3B JOSHUA CT
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3640
Mailing Address - Country:US
Mailing Address - Phone:845-352-0320
Mailing Address - Fax:
Practice Address - Street 1:3B JOSHUA CT
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3640
Practice Address - Country:US
Practice Address - Phone:845-352-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1118632222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDY98741EMedicaid