Provider Demographics
NPI:1902358351
Name:KLAUCK, VASO B
Entity Type:Individual
Prefix:MRS
First Name:VASO
Middle Name:B
Last Name:KLAUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:B
Other - Last Name:RONTIRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22004 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22004 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1621
Practice Address - Country:US
Practice Address - Phone:171-871-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency