Healthcare Provider Details

I. General information

NPI: 1659104016
Provider Name (Legal Business Name): STEFANIE RACHELLE KLIGMAN DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 3RD AVE
NEW YORK NY
10003-2501
US

IV. Provider business mailing address

2 JOHNSON PL
RYE NY
10580-1141
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-7712
  • Fax:
Mailing address:
  • Phone: 917-716-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number064198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: