MEDICARE: MRS. DANA JILL KLIGMAN

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	235Z00000X	Speech-Language Pathologist	014853-1	NY

General Provider Information

NPI Number	:	1750690319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA JILL KLIGMAN

Provider Business Mailing Address
First Line	:	4555 HENRY HUDSON PKWY
Second Line	:	APT. 311
City	:	BRONX
State	:	NY
Zip	:	10471-3836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 HENRY HUDSON PKWY
Second Line	:	APT. 311
City	:	BRONX
State	:	NY
Zip	:	10471-3836
Country	:	US
Telephone Number	:	917-689-8007
Fax Number	:

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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