Provider Demographics
NPI:1598777310
Name:KLEEMAN, JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KLEEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 YORKSHIP SQ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-2865
Mailing Address - Country:US
Mailing Address - Phone:856-541-5588
Mailing Address - Fax:856-338-9223
Practice Address - Street 1:2961 YORKSHIP SQ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-2865
Practice Address - Country:US
Practice Address - Phone:856-541-5588
Practice Address - Fax:856-338-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05214200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5054907Medicaid
NJ5054907Medicaid
NJ713924PG4Medicare ID - Type Unspecified