Basic Information
| Provider Information | |||||||||
| NPI: | 1841335577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLINDO | ||||||||
| FirstName: | MARINA | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3611 31ST AVE APT 4B | ||||||||
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| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111061013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155252693 | ||||||||
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| Practice Location | |||||||||
| Address1: | 585 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117585023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167971234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 011383 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.