Provider Demographics
NPI:1336370493
Name:KLEINBURD, MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KLEINBURD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2351
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:
Practice Address - Street 1:194 JORALEMON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4312
Practice Address - Country:US
Practice Address - Phone:718-643-7116
Practice Address - Fax:718-643-7119
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0310842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic