Provider Demographics
NPI:1578732277
Name:NEIL KLEIN DPM FACFAS PA
Entity Type:Organization
Organization Name:NEIL KLEIN DPM FACFAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-286-7115
Mailing Address - Street 1:6212 SE FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8108
Mailing Address - Country:US
Mailing Address - Phone:772-286-7115
Mailing Address - Fax:772-286-7778
Practice Address - Street 1:6212 SE FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8108
Practice Address - Country:US
Practice Address - Phone:772-286-7115
Practice Address - Fax:772-286-7778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIL KLEIN DPM FACFAS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1184213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
87705Medicare PIN
4731110001Medicare NSC
T55510Medicare UPIN