Basic Information
| Provider Information | |||||||||
| NPI: | 1477690840 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIC G. KLAUSNER, MD, PLLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | NATHAN LITTAUER HOSPITAL AND NH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | STATE HIGHWAY 30 | ||||||||
| Address2: | PERTH PRIMARY CARE CENTER | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | PERTH PRIMARY CARE CENTER STATE HIGHWAY 30 | ||||||||
| Address2: | STATE HIGHWAY 30 | ||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | KLAUSNER | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | GRANT | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5188838620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 180976 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1518982982 | 01 | NY | INDIVIDUAL NPI | OTHER | F333567 | 01 | NY | THERESA KLAUSNER | OTHER | 01279161 | 05 | NY | MEDICAID | 180976 | 01 | NY | ERIC KLAUSNER LICENSE | OTHER | 1265587117 | 01 | NY | THERESA KLAUSNER NPI | OTHER |