Provider Demographics
NPI:1134161987
Name:KLINE, BRADLEY HOWARD
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:HOWARD
Last Name:KLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 US HIGHWAY 1 STE 1
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2157
Mailing Address - Country:US
Mailing Address - Phone:732-274-2127
Mailing Address - Fax:732-274-2127
Practice Address - Street 1:4105 US HIGHWAY 1
Practice Address - Street 2:SUITE 1
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2157
Practice Address - Country:US
Practice Address - Phone:732-329-8585
Practice Address - Fax:732-329-5668
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04326600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222815871Medicare UPIN
NJKL479639Medicare ID - Type Unspecified