Provider Demographics
NPI:1871665976
Name:KLESTZICK, HAROLD N (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:N
Last Name:KLESTZICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10504
Mailing Address - Country:US
Mailing Address - Phone:718-239-5877
Mailing Address - Fax:718-239-6957
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-239-5877
Practice Address - Fax:718-239-6957
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195483207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971168Medicaid
NY01971168Medicaid
NY39N551Medicare ID - Type Unspecified