Provider Demographics
NPI:1851327761
Name:KLEIN, JONATHAN (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 OCEANSIDE RD E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5977
Mailing Address - Country:US
Mailing Address - Phone:718-544-7575
Mailing Address - Fax:718-544-7132
Practice Address - Street 1:3757 OCEANSIDE RD E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5977
Practice Address - Country:US
Practice Address - Phone:718-544-7575
Practice Address - Fax:718-544-7132
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005256-1213E00000X
NY005256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01779299Medicaid
NY01779299Medicaid
NY6107840001Medicare NSC
NYPG7391Medicare PIN
NYU66207Medicare UPIN