Provider Demographics
NPI:1942232889
Name:KLEIN, ALAN R (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-1629
Mailing Address - Country:US
Mailing Address - Phone:631-775-0320
Mailing Address - Fax:631-775-0320
Practice Address - Street 1:73 GLENVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-775-0320
Practice Address - Fax:631-775-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ052211Medicare PIN