Healthcare Provider Details

I. General information

NPI: 1376487769
Provider Name (Legal Business Name): LISA M KLEIN M.S. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST STE 200
FOREST HILLS NY
11375-4739
US

IV. Provider business mailing address

272 GREELEY AVE
STATEN ISLAND NY
10306-3233
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax: 718-886-8694
Mailing address:
  • Phone: 718-762-7633
  • Fax: 718-886-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1165399171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: