Provider Demographics
NPI:1700346376
Name:KLYACHMAN, LESLIE ESTHER (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ESTHER
Last Name:KLYACHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HEDGE LN
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2211
Mailing Address - Country:US
Mailing Address - Phone:516-589-4494
Mailing Address - Fax:
Practice Address - Street 1:GME OFFICE STONY BROOK HSC LEVEL 4 - RM 176
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-638-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program