Healthcare Provider Details

I. General information

NPI: 1497439145
Provider Name (Legal Business Name): SERGEI KLOKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 01/17/2024
Reactivation Date: 01/18/2024

III. Provider practice location address

70 DUBOIS STREET MONTEFIORE ST. LUKES CORNWALL
NEWBURGH NY
12550
US

IV. Provider business mailing address

70 DUBOIS STREET MONTEFIORE ST. LUKES CORNWALL
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-458-4883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number345168
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number345168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: