Provider Demographics
NPI:1356487805
Name:BRUCE D KLASKIN DO FAAPMR FACPM PC
Entity Type:Organization
Organization Name:BRUCE D KLASKIN DO FAAPMR FACPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-845-1553
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-0175
Mailing Address - Country:US
Mailing Address - Phone:570-988-0925
Mailing Address - Fax:570-988-0919
Practice Address - Street 1:1030 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3862
Practice Address - Country:US
Practice Address - Phone:717-845-1553
Practice Address - Fax:717-845-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007241900002Medicaid
PA0007241900002Medicaid