Provider Demographics
NPI:1245366475
Name:KLEIMAN, JERRY I (PHD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:I
Last Name:KLEIMAN
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 1:75 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2301
Mailing Address - Country:US
Mailing Address - Phone:516-365-7192
Mailing Address - Fax:516-365-7192
Practice Address - Street 1:75 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2301
Practice Address - Country:US
Practice Address - Phone:516-365-7192
Practice Address - Fax:516-365-7192
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical