Provider Demographics
NPI:1093842130
Name:KLIPSTEIN MEDICAL GROUP PC
Entity Type:Organization
Organization Name:KLIPSTEIN MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLIPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-646-8044
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3536
Mailing Address - Country:US
Mailing Address - Phone:860-646-8044
Mailing Address - Fax:860-643-4891
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3536
Practice Address - Country:US
Practice Address - Phone:860-646-8044
Practice Address - Fax:860-643-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00121Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER