Healthcare Provider Details

I. General information

NPI: 1568843217
Provider Name (Legal Business Name): BETSY KLINGER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

56 LOCUST AVE
MILLBURN NJ
07041-1554
US

V. Phone/Fax

Practice location:
  • Phone: 917-499-4006
  • Fax:
Mailing address:
  • Phone: 917-499-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number286710
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB11103800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: