Basic Information
| Provider Information | |||||||||
| NPI: | 1639619075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLUESENER | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ROSA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROSA | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | AILEEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 222 E 41ST STREET | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124258000 | ||||||||
| FaxNumber: | 2122038885 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 E 41ST STREET | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124258000 | ||||||||
| FaxNumber: | 2122038885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2017 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 708952 | NY | N | Nursing Service Providers | Registered Nurse | Pediatrics | 363LF0000X | F342668-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 342668 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.