Individual
DR. LARISA V. KLEYMENOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5115 BEACH CHANNEL DR, FAR ROCKAWAY, NY 11691-1042
(212) 563-2627
(212) 563-0605
Mailing address
158 W 27TH ST, 11TH FLOOR SOUTH, NEW YORK, NY 10001-6216
(212) 563-2627
(212) 563-0605
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
230116
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02498626
—
NY
Enumeration date
02/23/2007
Last updated
07/09/2007
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