Provider Demographics
NPI:1700978566
Name:KLEINBERG, CHARLES C (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:KLEINBERG
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 1:1000 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0934
Mailing Address - Country:US
Mailing Address - Phone:212-288-1399
Mailing Address - Fax:212-288-9130
Practice Address - Street 1:1000 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0934
Practice Address - Country:US
Practice Address - Phone:212-288-1399
Practice Address - Fax:212-288-9130
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127745207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00852511Medicaid
NY74A201Medicare PIN
NYB19135Medicare UPIN
NY00852511Medicaid