Provider Demographics
NPI:1265549042
Name:KLEIN, RANDY S (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:S
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149M HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-782-7700
Mailing Address - Fax:908-782-3644
Practice Address - Street 1:149M HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5739
Practice Address - Country:US
Practice Address - Phone:908-782-7700
Practice Address - Fax:908-782-3644
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO4454700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD07108Medicare UPIN
NJ526758Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER