Provider Demographics
NPI:1932136231
Name:KLINE, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:KLINE
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 1:700 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7098
Mailing Address - Country:US
Mailing Address - Phone:212-517-6555
Mailing Address - Fax:
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7098
Practice Address - Country:US
Practice Address - Phone:212-517-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9681544OtherGHI
NYNS651OtherOXFORD INS
NYNY5967OtherHEALTHNET
NY004262282OtherAETNA
NY3K6710OtherBLUECROSS/BLUESHIELD
NYNS651OtherOXFORD INS
NYNY5967OtherHEALTHNET