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General NPI Number Information
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NPI Number | 1861816985
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Entity Type | Organization
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Legal Business Name | JANI L. KLEBANOW
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 19 W 34TH ST PH SUITE
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 917-763-3232
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Fax | 212-239-0948
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Provider Business Mailing Address
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Address Line | 19 W 34TH ST PENTHOUSE SUITE
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 917-763-3232
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Fax | 212-239-0948
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JANI L. KLEBANOW
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Credential | PH.D.
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Telephone | 917-763-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 011039-2
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License Number State | NY
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