1912267501 NPI number — FIANA KLEIN DO

Table of content: FIANA KLEIN DO (NPI 1912267501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912267501 NPI number — FIANA KLEIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
FIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912267501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT OF PSYCHIATRY
Provider Second Line Business Mailing Address:
75-59 263 STREET
Provider Business Mailing Address City Name:
GLEN OAKS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-470-4068
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY & BEHAVIORAL SCIENCE
Provider Second Line Business Practice Location Address:
STONY BROOK UNIVERSITY MEDICAL CENTER HSC T-10 ROOM 020
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-3005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  281963-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 281963-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)