MEDICARE: JANET S. KLOSKO PH.D.

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	103T00000X	Psychologist	10331	NY

General Provider Information

NPI Number	:	1417019118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET S. KLOSKO PH.D.

Provider Business Mailing Address
First Line	:	450 OHAYO MOUNTAIN RD
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-2516
Country	:	US
Telephone Number	:	845-657-9809
Fax Number	:	845-657-6173

Provider Business Practice Location Address
First Line	:	11 MIDDLE NECK RD
Second Line	:	STE 312
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2301
Country	:	US
Telephone Number	:	516-466-8485
Fax Number	:

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

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	04/22/2017

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