=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760545420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LLOYD KENNETH KLAUSNER D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 CENTRAL PARK S SUITE 3C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-888-8889
-----------------------------------------------------
Fax | 646-264-0015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 DEEPWOOD RD
-----------------------------------------------------
City | ROSLYN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11577-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-484-7388
-----------------------------------------------------
Fax | 646-264-0015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 042166
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------