MEDICARE: MARIYA KLEYNERMAN M.S.,P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	019226	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275683807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIYA KLEYNERMAN M.S.,P.T.

Provider Business Mailing Address
First Line	:	136 NORFOLK ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3019 BRIGHTON 1ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8008
Country	:	US
Telephone Number	:	718-743-9700
Fax Number	:	718-332-3511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	11/12/2019

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