MEDICARE: ATLANTIC CITY GYNECOLOGY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	10161 A	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710013198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC CITY GYNECOLOGY GROUP

Provider Business Mailing Address
First Line	:	1616 PACIFIC AVE
Second Line	:	SUITE 316
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6939
Country	:	US
Telephone Number	:	609-344-4554
Fax Number	:	609-348-2565

Provider Business Practice Location Address
First Line	:	1616 PACIFIC AVE
Second Line	:	SUITE 316
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6939
Country	:	US
Telephone Number	:	609-344-4554
Fax Number	:	609-348-2565

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALLEN J KLINE
Credential	:	D.O.
Telephone Number	:	60934445554

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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