Provider Demographics
NPI:1316416662
Name:KLEINER, MITCHELL JAY
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:JAY
Last Name:KLEINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SHINNECOCK DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9501
Mailing Address - Country:US
Mailing Address - Phone:732-995-4824
Mailing Address - Fax:
Practice Address - Street 1:14 FARBER RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5913
Practice Address - Country:US
Practice Address - Phone:732-995-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06050700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker