Provider Demographics
NPI:1639424617
Name:KLEINBERG, JEFFREY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:KLEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVENUE
Mailing Address - Street 2:C-350
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2539
Mailing Address - Country:US
Mailing Address - Phone:954-731-9676
Mailing Address - Fax:954-731-9747
Practice Address - Street 1:4701 N. FEDERAL HWY
Practice Address - Street 2:#370
Practice Address - City:POPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6874
Practice Address - Country:US
Practice Address - Phone:954-941-5731
Practice Address - Fax:954-941-2706
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012380000Medicaid