Basic Information
Provider Information | |||||||||
NPI: | 1235161290 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KLASS | ||||||||
FirstName: | SHERI | ||||||||
MiddleName: | JO | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOW | ||||||||
OtherFirstName: | SHERI | ||||||||
OtherMiddleName: | J | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | FNP/GNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 28 TULIP CT | ||||||||
Address2: |   | ||||||||
City: | NANUET | ||||||||
State: | NY | ||||||||
PostalCode: | 109543804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8456428813 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2016 BRONXDALE AVE | ||||||||
Address2: | SUITE 301 | ||||||||
City: | BRONX | ||||||||
State: | NY | ||||||||
PostalCode: | 10462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7184092222 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2006 | ||||||||
LastUpdateDate: | 03/23/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 33 334330 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.