Healthcare Provider Details

I. General information

NPI: 1023304789
Provider Name (Legal Business Name): MEGAN A KLANSKY D.O., J.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR # UMDNJSOM
STRATFORD NJ
08084-1500
US

IV. Provider business mailing address

1 MEDICAL CENTER DR # UMDNJSOM
STRATFORD NJ
08084-1500
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6708
  • Fax: 856-566-6222
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: