Healthcare Provider Details

I. General information

NPI: 1669774360
Provider Name (Legal Business Name): ELIZABETH S KLEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN SIMPSON PA-C

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD STE 201
LINWOOD NJ
08221-1281
US

IV. Provider business mailing address

950 PULASKI DR STE 100
KING OF PRUSSIA PA
19406-2802
US

V. Phone/Fax

Practice location:
  • Phone: 609-788-8593
  • Fax: 609-904-6929
Mailing address:
  • Phone: 610-768-5945
  • Fax: 610-768-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00249100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: