Provider Demographics
NPI:1255449724
Name:KLACHKO, DARIA (MD)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:KLACHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2217
Mailing Address - Country:US
Mailing Address - Phone:973-325-5670
Mailing Address - Fax:
Practice Address - Street 1:769 NORTHFIELD AVE
Practice Address - Street 2:SUITE 236
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1198
Practice Address - Country:US
Practice Address - Phone:973-325-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG56297Medicare UPIN
NJ901676Medicare ID - Type Unspecified