Provider Demographics
NPI:1982732582
Name:KLENOFF, BRUCE HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HOWARD
Last Name:KLENOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:HOWARD
Other - Last Name:KLENOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:TULLY HEALTH CENTER SUITE 4
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-353-0000
Mailing Address - Fax:
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:TULLY HEALTH CENTER SUITE 4
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-353-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17766207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84032Medicare UPIN