Active NPI
Jani L Klebanow, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1124054267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 011309-1
- Practice address
- 19 West 34 Street
PH Suite
New York, NY 10001-3006 - Phone
- (917) 763-3232
- Fax
- (212) 239-0948
- NPI assigned
- Jun 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 011309-1 | NY | Primary |
Addresses
Primary practice location
19 West 34 Street
PH Suite
New York, NY 10001-3006
Mailing address
19 West 34 Street
PH Suite
New York, NY 10001-3006
Phone (917) 763-3232
Other practice location 1
10 Terrace Dr
Huntington Station, NY 11746-1243
Phone (631) 351-7520
Other practice location 2
10 Terrace Dr
Huntington Station, NY 11746-1243
Phone (631) 351-7520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01405114 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011309-1 | NY | MD | Speech-Language Pathologist |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1124054267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 WEST 34 STREET",
"address_2": "PH SUITE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100013006",
"telephone_number": "917-763-3232",
"fax_number": "212-239-0948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 WEST 34 STREET",
"address_2": "PH SUITE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100013006",
"telephone_number": "917-763-3232",
"fax_number": "212-239-0948"
}
],
"practiceLocations": [
{
"address_1": "10 Terrace Dr",
"address_purpose": "LOCATION",
"city": "Huntington Station",
"state": "NY",
"postal_code": "117461243",
"country_code": "US",
"telephone_number": "631-351-7520",
"fax_number": "631-351-7520",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10 Terrace Dr",
"address_purpose": "LOCATION",
"city": "Huntington Station",
"state": "NY",
"postal_code": "117461243",
"country_code": "US",
"telephone_number": "631-351-7520",
"fax_number": "631-351-7520",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KLEBANOW",
"first_name": "JANI",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "011309-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01405114",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.