Provider Demographics
NPI:1659104016
Name:KLIGMAN, STEFANIE RACHELLE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:RACHELLE
Last Name:KLIGMAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JOHNSON PL
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1141
Mailing Address - Country:US
Mailing Address - Phone:917-716-4738
Mailing Address - Fax:
Practice Address - Street 1:195 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2501
Practice Address - Country:US
Practice Address - Phone:212-477-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0641981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics