Provider Demographics
NPI:1902837396
Name:PETER A KLEIN, MD, FAAD, PC
Entity Type:Organization
Organization Name:PETER A KLEIN, MD, FAAD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-928-7922
Mailing Address - Street 1:6 MEDICAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1594
Mailing Address - Country:US
Mailing Address - Phone:631-928-7922
Mailing Address - Fax:631-928-9246
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1594
Practice Address - Country:US
Practice Address - Phone:631-928-7922
Practice Address - Fax:631-928-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ771Medicare PIN