Provider Demographics
NPI:1730450685
Name:STANLEY J KLEIN
Entity type:Organization
Organization Name:STANLEY J KLEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-463-8075
Mailing Address - Street 1:310 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7509
Mailing Address - Country:US
Mailing Address - Phone:718-761-0024
Mailing Address - Fax:
Practice Address - Street 1:310 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7585
Practice Address - Country:US
Practice Address - Phone:718-761-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002858-1211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, PodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP32171Medicare PIN