Provider Demographics
NPI:1871638270
Name:KLEBAN, CARL HENRY (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:HENRY
Last Name:KLEBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 LEXINGTON AVE
Mailing Address - Street 2:1E
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-876-4153
Mailing Address - Fax:212-876-6711
Practice Address - Street 1:1349 LEXINGTON AVE
Practice Address - Street 2:1E
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10128-1511
Practice Address - Country:US
Practice Address - Phone:212-876-4153
Practice Address - Fax:212-876-6711
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 1067122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
52221Medicare ID - Type Unspecified