Provider Demographics
NPI:1184775611
Name:KLEBER, MARC S (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:KLEBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W 75TH ST
Mailing Address - Street 2:SUITE 1-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1609
Mailing Address - Country:US
Mailing Address - Phone:212-579-8661
Mailing Address - Fax:
Practice Address - Street 1:304 W 75TH ST
Practice Address - Street 2:SUITE 1-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1609
Practice Address - Country:US
Practice Address - Phone:212-579-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013265-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV93361Medicare PIN