Provider Demographics
NPI:1649244930
Name:KLENOFF, PAUL HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HARVEY
Last Name:KLENOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-493-3337
Mailing Address - Fax:732-493-4463
Practice Address - Street 1:804 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-493-3337
Practice Address - Fax:732-493-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA027572207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS076OtherOXFORD
OK9792OtherHEALTHNET
0227878001OtherCIGNA
0110963000OtherAMERIHEALTH
33762OtherAETNA
36F952OtherEMPIRE BCBS
MS076OtherOXFORD