Provider Demographics
NPI:1972628865
Name:KLEYN, SOFYA
Entity Type:Individual
Prefix:
First Name:SOFYA
Middle Name:
Last Name:KLEYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:SUITE 1420
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:212-571-5000
Mailing Address - Fax:888-535-2703
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 1420
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:212-571-5000
Practice Address - Fax:888-535-2703
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243074207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWER591Medicare ID - Type UnspecifiedCORPORATION NUMBER