Basic Information
| Provider Information | |||||||||
| NPI: | 1093750580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLECATSKY | ||||||||
| FirstName: | LAWRENCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070390658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737400607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 GUION PL | ||||||||
| Address2: | SOUND SHORE MEDICAL CENTER OF WESTCHESTER | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146325000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 118284-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.