Healthcare Provider Details

I. General information

NPI: 1073514683
Provider Name (Legal Business Name): SUIYIN KLEINBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SOUTH ST SUITE 5
WARE MA
01082-1660
US

IV. Provider business mailing address

83 SOUTH ST SUITE 5
WARE MA
01082-1660
US

V. Phone/Fax

Practice location:
  • Phone: 413-967-0202
  • Fax: 413-967-4202
Mailing address:
  • Phone: 413-967-0202
  • Fax: 413-967-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number208324
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: