Provider Demographics
NPI:1861816985
Name:JANI L. KLEBANOW
Entity Type:Organization
Organization Name:JANI L. KLEBANOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLEBANOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-763-3232
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:PENTHOUSE SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:917-763-3232
Mailing Address - Fax:212-239-0948
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PH SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-763-3232
Practice Address - Fax:212-239-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011039-2103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01405114Medicaid
NY1124054267OtherNPI NUMBER
NYV5B771Medicare UPIN