Provider Demographics
NPI:1861512030
Name:KLELE, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:KLELE
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 1:257 ROUT 22 EAST
Mailing Address - Street 2:FAMILY CARE PA
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-9997
Mailing Address - Country:US
Mailing Address - Phone:732-968-7878
Mailing Address - Fax:732-968-2187
Practice Address - Street 1:257 ROUT 22 EAST
Practice Address - Street 2:FAMILY CARE PA
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-9997
Practice Address - Country:US
Practice Address - Phone:732-968-7878
Practice Address - Fax:732-968-2187
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438205207Q00000X
NJ25MA08749500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine