Healthcare Provider Details

I. General information

NPI: 1639424617
Provider Name (Legal Business Name): JEFFREY CHARLES KLEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N. FEDERAL HWY #370
POPANO BEACH FL
33064-6874
US

IV. Provider business mailing address

7800 SW 87TH AVENUE C-350
MIAMI FL
33173-2539
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-5731
  • Fax: 954-941-2706
Mailing address:
  • Phone: 954-731-9676
  • Fax: 954-731-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME119724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: