Provider Demographics
NPI:1205903978
Name:KLEIN, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:29 WAGON WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5025
Mailing Address - Country:US
Mailing Address - Phone:631-864-8395
Mailing Address - Fax:631-587-4830
Practice Address - Street 1:747 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4911
Practice Address - Country:US
Practice Address - Phone:631-587-4800
Practice Address - Fax:631-587-4830
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51G461Medicare PIN
NYG75441Medicare UPIN