Provider Demographics
NPI:1962443366
Name:KLEINSTEIN, SMADAR F (PA)
Entity Type:Individual
Prefix:
First Name:SMADAR
Middle Name:F
Last Name:KLEINSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2447
Mailing Address - Country:US
Mailing Address - Phone:973-341-7348
Mailing Address - Fax:
Practice Address - Street 1:1355 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4221
Practice Address - Country:US
Practice Address - Phone:973-778-5566
Practice Address - Fax:973-778-4044
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP000772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083217Medicare ID - Type Unspecified
NJQ23641Medicare UPIN