Provider Demographics
NPI:1245344670
Name:KLEINBAUM, JERRY I (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:I
Last Name:KLEINBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:48 MAHOPAC AVE ROUTE 6
Practice Address - Street 2:CARE MOUNT MEDICAL, PC
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-248-5556
Practice Address - Fax:914-248-4091
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-11-15
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Provider Licenses
StateLicense IDTaxonomies
NY136935207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00559980Medicaid
NY35A241Medicare PIN
NY00559980Medicaid
NYA400009995Medicare PIN