=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477690840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC G. KLAUSNER, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 03/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PERTH PRIMARY CARE CENTER STATE HIGHWAY 30 STATE HIGHWAY 30
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-883-8620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | STATE HIGHWAY 30 PERTH PRIMARY CARE CENTER
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-883-8620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. ERIC GRANT KLAUSNER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-883-8620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 180976
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------