Provider Demographics
NPI:1982690574
Name:KLEIN, SHAWN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:R
Last Name:KLEIN
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 1:230 W JERSEY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-289-1166
Mailing Address - Fax:908-352-4752
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-289-1166
Practice Address - Fax:908-352-4752
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07293500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0037907Medicaid
NJ0037907Medicaid
NJ082927BKZMedicare PIN
NJH96369Medicare UPIN