Provider Demographics
NPI:1255167110
Name:PAVEL KLEIN
Entity type:Organization
Organization Name:PAVEL KLEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PROVIDER/PARTNE
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANCMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-428-3651
Mailing Address - Street 1:PO BOX 782438
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2438
Mailing Address - Country:US
Mailing Address - Phone:301-530-9745
Mailing Address - Fax:301-530-0046
Practice Address - Street 1:1715 N GEORGE MASON DR STE 107
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3642
Practice Address - Country:US
Practice Address - Phone:301-530-9744
Practice Address - Fax:301-530-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty