Provider Demographics
NPI:1891760666
Name:KLEINMAN, BRENDA L (PAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 BUSHKILL PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-9665
Mailing Address - Country:US
Mailing Address - Phone:610-863-7020
Mailing Address - Fax:610-863-5504
Practice Address - Street 1:497 BUSHKILL PLAZA LN
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9665
Practice Address - Country:US
Practice Address - Phone:610-863-7020
Practice Address - Fax:610-863-5504
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000913L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17837Medicare ID - Type UnspecifiedMEDICARE
PAS63438Medicare UPIN