Provider Demographics
NPI:1952801755
Name:KLEMOW, EZRA N (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:N
Last Name:KLEMOW
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LAREINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1339
Mailing Address - Country:US
Mailing Address - Phone:908-251-7358
Mailing Address - Fax:
Practice Address - Street 1:408 LAREINE AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720
Practice Address - Country:US
Practice Address - Phone:908-251-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01778700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist