Provider Demographics
NPI:1790835668
Name:KLEIN, ELI (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 49TH ST
Mailing Address - Street 2:#366
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3011
Mailing Address - Country:US
Mailing Address - Phone:718-851-2400
Mailing Address - Fax:718-871-6732
Practice Address - Street 1:1541 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5023
Practice Address - Country:US
Practice Address - Phone:718-851-2400
Practice Address - Fax:718-871-6732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4080430001Medicare ID - Type UnspecifiedPROVIDER NUMBER