MEDICARE: DR. JOHN ERASMUS KLIBANOFF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	198309	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200026915	OTHER	NY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255391652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ERASMUS KLIBANOFF MD

Provider Business Mailing Address
First Line	:	17 LANGSING ST
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-1983
Country	:	US
Telephone Number	:	315-255-7011
Fax Number	:	315-255-7099

Provider Business Practice Location Address
First Line	:	77 NELSON ST
Second Line	:	STE 120
City	:	AUBURN
State	:	NY
Zip	:	13021-1941
Country	:	US
Telephone Number	:	315-252-7559
Fax Number	:	315-253-8104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/03/2024

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