Provider Demographics
NPI:1295990620
Name:KLEBANOVA, GALINA (RN)
Entity type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:KLEBANOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 OCEAN AVE
Mailing Address - Street 2:6K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4666
Mailing Address - Country:US
Mailing Address - Phone:718-891-1696
Mailing Address - Fax:
Practice Address - Street 1:80 BROAD ST
Practice Address - Street 2:14 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2209
Practice Address - Country:US
Practice Address - Phone:212-867-6530
Practice Address - Fax:212-867-6535
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY479915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse