Provider Demographics
NPI:1720102759
Name:KLEIN, LEE ANN
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 PALMER AVE
Mailing Address - Street 2:SUITE # 1-C
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2930
Mailing Address - Country:US
Mailing Address - Phone:914-954-6865
Mailing Address - Fax:914-633-0278
Practice Address - Street 1:2261 PALMER AVE
Practice Address - Street 2:SUITE # 1-C
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2930
Practice Address - Country:US
Practice Address - Phone:914-954-6865
Practice Address - Fax:914-633-0278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005348-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9306E1Medicare PIN