Provider Demographics
NPI:1073514683
Name:KLEINBERG, SUIYIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUIYIN
Middle Name:
Last Name:KLEINBERG
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 1:83 SOUTH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-1660
Mailing Address - Country:US
Mailing Address - Phone:413-967-0202
Mailing Address - Fax:413-967-4202
Practice Address - Street 1:83 SOUTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1660
Practice Address - Country:US
Practice Address - Phone:413-967-0202
Practice Address - Fax:413-967-4202
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22990OtherBLUE CROSS PROVIDER ID
MA0111911Medicaid
MAJ22990OtherBLUE CROSS PROVIDER ID
MAF69114Medicare UPIN