Provider Demographics
NPI:1518250745
Name:SAMUEL C KLAGSBRUN, MD, PC
Entity type:Organization
Organization Name:SAMUEL C KLAGSBRUN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLAGSBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-763-8151
Mailing Address - Street 1:800 CROSS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3549
Mailing Address - Country:US
Mailing Address - Phone:914-763-8151
Mailing Address - Fax:914-763-9597
Practice Address - Street 1:595 MADISON AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1907
Practice Address - Country:US
Practice Address - Phone:914-763-8151
Practice Address - Fax:914-763-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090545-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty