Provider Demographics
NPI:1154489318
Name:MITCHELL A. KLINE MD PC
Entity Type:Organization
Organization Name:MITCHELL A. KLINE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGISTS PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:212-517-6555
Mailing Address - Street 1:700 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4930
Mailing Address - Country:US
Mailing Address - Phone:212-517-6555
Mailing Address - Fax:212-476-6796
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4930
Practice Address - Country:US
Practice Address - Phone:212-517-6555
Practice Address - Fax:212-476-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004262282OtherAETNA PROVIDER NUMBER
NY3K6711OtherBLUECROSS PROVIDER NUMBER
NYNS651OtherOXFORD
NJ22099OtherHORIZON PROVIDER NUMBER
NY9681544OtherGHI
NYNY5967OtherHEALTHNET PROVIDER NUMBER
NYNY5967OtherHEALTHNET PROVIDER NUMBER
NYNS651OtherOXFORD
NY=========OtherCIGNA PROVIDER NUMBER
NY=========Other21ST CENTURY PROVIDER NUM
NYNS651OtherOXFORD
NY=========Other21ST CENTURY PROVIDER NUM