Provider Demographics
NPI:1003546706
Name:KLOSSEK, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:KLOSSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ISIAS CT
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-5229
Mailing Address - Country:US
Mailing Address - Phone:908-943-5684
Mailing Address - Fax:
Practice Address - Street 1:540 BORDENTOWN AVE STE 10B
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1576
Practice Address - Country:US
Practice Address - Phone:732-553-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant