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General NPI Number Information
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NPI Number | 1346132974
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Entity Type | Individual
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Provider Name | MARIA KLYSHKO
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Gender |
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4400 VESTAL PKWY E
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City | BINGHAMTON
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State | NY
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Zip | 13902-4400
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Country | US
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Telephone | 347-653-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 44 RIDGEFIELD RD
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City | WARWICK
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State | NY
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Zip | 10990-3543
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Country | US
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Telephone | 347-653-5044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | 892688
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License Number State | NY
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