Healthcare Provider Details

I. General information

NPI: 1568653376
Provider Name (Legal Business Name): BRIAN JEFFREY KLEIN D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ROUTE 10 SUITE 5
RANDOLPH NJ
07869-2132
US

IV. Provider business mailing address

447 ROUTE 10 SUITE 5
RANDOLPH NJ
07869-2132
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-1555
  • Fax: 973-328-3405
Mailing address:
  • Phone: 973-328-1555
  • Fax: 973-328-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number054701
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02299900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: