Provider Demographics
NPI:1073643706
Name:KLEIN, LAURA B (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:KLEIN
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 1:1 DOGWOOD DRIVE
Mailing Address - Street 2:P.O. BOX 5388
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809
Mailing Address - Country:US
Mailing Address - Phone:908-735-4477
Mailing Address - Fax:908-735-6532
Practice Address - Street 1:1 DOGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801
Practice Address - Country:US
Practice Address - Phone:908-735-4477
Practice Address - Fax:908-735-6532
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA081320002085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0117595Medicaid