Provider Demographics
NPI:1760027585
Name:KLEINBERG, STEFANIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MICHELLE
Last Name:KLEINBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BREWSTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1465
Mailing Address - Country:US
Mailing Address - Phone:631-645-3478
Mailing Address - Fax:
Practice Address - Street 1:40 BREWSTER HILL RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1465
Practice Address - Country:US
Practice Address - Phone:631-645-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant