Healthcare Provider Details

I. General information

NPI: 1144407099
Provider Name (Legal Business Name): MICHAEL JOSEPH KLUK MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE.
NEW YORK NY
10065
US

IV. Provider business mailing address

1275 YORK AVE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-3351
  • Fax:
Mailing address:
  • Phone: 212-639-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number277996
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number277996
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number277996
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number277996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: