Provider Demographics
NPI:1326038084
Name:KLEIN, DEBRA B (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:B
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6965
Mailing Address - Country:US
Mailing Address - Phone:856-783-3366
Mailing Address - Fax:856-782-1648
Practice Address - Street 1:1130 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6965
Practice Address - Country:US
Practice Address - Phone:856-783-3366
Practice Address - Fax:856-782-1648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0550809Medicaid
T77756Medicare UPIN
NJ0550809Medicaid