Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 011189 | NY |
NPI | 1356662399 |
---|---|
Provider Name | Dr. Michelle Klein |
First Address | Great Neck, NY 11023-2410 |
Second Address | Great Neck, NY 11023-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 14/06/2010 |