Provider Demographics
NPI:1700901857
Name:KLEIN, JEFFREY (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BROADWAY
Mailing Address - Street 2:CONCOURSE LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5007
Mailing Address - Country:US
Mailing Address - Phone:212-354-2225
Mailing Address - Fax:212-354-1954
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:CONCOURSE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5007
Practice Address - Country:US
Practice Address - Phone:212-354-2225
Practice Address - Fax:212-354-1954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX83861Medicare ID - Type Unspecified
NYU68931Medicare UPIN