Provider Demographics
NPI:1669762290
Name:KLEINERT, KELLY J (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:KLEINERT
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 1:198 E 121ST ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3523
Mailing Address - Country:US
Mailing Address - Phone:917-331-7339
Mailing Address - Fax:
Practice Address - Street 1:665 PELHAM PKWY N
Practice Address - Street 2:SUITE 402
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8068
Practice Address - Country:US
Practice Address - Phone:718-519-8326
Practice Address - Fax:646-335-0675
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2669522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry