Provider Demographics
NPI:1356341556
Name:KLAZMER, JAY (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:KLAZMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 N MAPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1782
Mailing Address - Country:US
Mailing Address - Phone:856-596-0558
Mailing Address - Fax:856-596-4043
Practice Address - Street 1:73 N MAPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1782
Practice Address - Country:US
Practice Address - Phone:856-596-0558
Practice Address - Fax:856-596-4043
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-005115-L2084N0400X
NJ25MB048159002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE60095Medicare UPIN