Provider Demographics
NPI:1821096454
Name:KLEIN, LESLIE (DC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5107
Mailing Address - Country:US
Mailing Address - Phone:718-769-2521
Mailing Address - Fax:718-646-1911
Practice Address - Street 1:3500 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5107
Practice Address - Country:US
Practice Address - Phone:718-769-2521
Practice Address - Fax:718-646-1911
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX22Y2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52023Medicare UPIN
X13172Medicare PIN