Provider Demographics
NPI:1053634956
Name:BRADLEY H KLINE DO LLC
Entity Type:Organization
Organization Name:BRADLEY H KLINE DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-329-8585
Mailing Address - Street 1:4105 US HIGHWAY 1
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2157
Mailing Address - Country:US
Mailing Address - Phone:732-329-8585
Mailing Address - Fax:732-329-5668
Practice Address - Street 1:4105 US HIGHWAY 1
Practice Address - Street 2:SUITE ONE
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2157
Practice Address - Country:US
Practice Address - Phone:732-329-8585
Practice Address - Fax:732-329-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04326600261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54065Medicare UPIN