Provider Demographics
NPI:1669444147
Name:KLEIN, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6 MEDICAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1594
Mailing Address - Country:US
Mailing Address - Phone:631-928-7922
Mailing Address - Fax:631-928-9246
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1594
Practice Address - Country:US
Practice Address - Phone:631-928-7922
Practice Address - Fax:631-928-9246
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH35233Medicare UPIN