Healthcare Provider Details

I. General information

NPI: 1033324082
Provider Name (Legal Business Name): ROXANA KLINE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 SUMMIT AVE
HACKENSACK NJ
07601-1430
US

IV. Provider business mailing address

332 SUMMIT AVE
HACKENSACK NJ
07601-1430
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-6445
  • Fax: 201-488-6441
Mailing address:
  • Phone: 201-488-6445
  • Fax: 201-488-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA06748600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROXANA KLINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-488-6445