Provider Demographics
NPI:1245580844
Name:KLEBAN, MARY JUSTYNA (PT, DPT, ATRIC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JUSTYNA
Last Name:KLEBAN
Suffix:
Gender:F
Credentials:PT, DPT, ATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3912
Mailing Address - Country:US
Mailing Address - Phone:908-580-3880
Mailing Address - Fax:
Practice Address - Street 1:9000 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3912
Practice Address - Country:US
Practice Address - Phone:908-580-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01285500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist