Provider Demographics
NPI:1114240066
Name:KLING, MARY TERESA (BS, DTR, PCD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:KLING
Suffix:
Gender:F
Credentials:BS, DTR, PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 ILENE LN
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1230
Mailing Address - Country:US
Mailing Address - Phone:856-889-9800
Mailing Address - Fax:
Practice Address - Street 1:2316 ILENE LN
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1230
Practice Address - Country:US
Practice Address - Phone:856-889-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered