MEDICARE: CARL HENRY KLEBAN 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	2084P0800X	Psychiatry Physician	NY 106712	NY

General Provider Information

NPI Number	:	1871638270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL HENRY KLEBAN MD

Provider Business Mailing Address
First Line	:	1349 LEXINGTON AVE
Second Line	:	1E
City	:	NY
State	:	NY
Zip	:	10128
Country	:	US
Telephone Number	:	212-876-4153
Fax Number	:	212-876-6711

Provider Business Practice Location Address
First Line	:	1349 LEXINGTON AVE
Second Line	:	1E
City	:	NY
State	:	NY
Zip	:	10128-1511
Country	:	US
Telephone Number	:	212-876-4153
Fax Number	:	212-876-6711

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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