Provider Demographics
NPI:1679878458
Name:KLEIN, JESSICA I (LMT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:I
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1911
Mailing Address - Country:US
Mailing Address - Phone:516-317-7210
Mailing Address - Fax:
Practice Address - Street 1:26 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1911
Practice Address - Country:US
Practice Address - Phone:516-317-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021665-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist