Provider Demographics
NPI:1255974200
Name:KLAUS, KEREN (LAC)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:KLAUS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14716 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2009
Mailing Address - Country:US
Mailing Address - Phone:347-251-1003
Mailing Address - Fax:
Practice Address - Street 1:75 N HANGAR RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11430-1826
Practice Address - Country:US
Practice Address - Phone:718-656-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003436171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist