Healthcare Provider Details

I. General information

NPI: 1215037981
Provider Name (Legal Business Name): ROXANA G. KLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
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 TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA06748600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery 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:
Title or Position:
Credential:
Phone: