Healthcare Provider Details

I. General information

NPI: 1952194722
Provider Name (Legal Business Name): RUSSELL KLEINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BUTTERNUT RD
BRIARCLIFF MANOR NY
10510-2223
US

IV. Provider business mailing address

116 BUTTERNUT RD
BRIARCLIFF MANOR NY
10510-2223
US

V. Phone/Fax

Practice location:
  • Phone: 914-309-1151
  • Fax:
Mailing address:
  • Phone: 914-309-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number473341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: