Provider Demographics
NPI:1821099078
Name:KLEIN, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:KLEIN
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 1:24 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1902
Mailing Address - Country:US
Mailing Address - Phone:201-784-0123
Mailing Address - Fax:201-784-0065
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1902
Practice Address - Country:US
Practice Address - Phone:201-784-0123
Practice Address - Fax:201-784-0065
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05761800207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5200709Medicaid
NJ0K6751OtherHEALTHNET ID #
NJ10L612OtherEMPIRE HC (TE) #
NJ527134OtherAETNA HMO ID #
NJ0557586000OtherKEYSTONE #
NJBP307OtherOXFORD #
NJ0557586000OtherAMERIHEALTH ID #
NJ10L613OtherEMPIRE HC (NV) #
NJ10L611OtherEMPIRE HC (HP) #
NJ4318882OtherAETNA PPO ID #
NJ527134OtherAETNA HMO ID #
NJ720451C3JMedicare PIN