Provider Demographics
NPI:1093033235
Name:DR. IRVING J. KLEIN,PA
Entity Type:Organization
Organization Name:DR. IRVING J. KLEIN,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-456-0400
Mailing Address - Street 1:237 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1718
Mailing Address - Country:US
Mailing Address - Phone:856-456-0400
Mailing Address - Fax:856-456-3011
Practice Address - Street 1:237 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1718
Practice Address - Country:US
Practice Address - Phone:856-456-0400
Practice Address - Fax:856-456-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02059100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2705206Medicaid
NJ2705206Medicaid
E06059Medicare UPIN