Healthcare Provider Details

I. General information

NPI: 1104009273
Provider Name (Legal Business Name): KRISTIN LYNN KLEIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 LAUREL OAK RD SUITE 130
VOORHEES NJ
08043-4419
US

IV. Provider business mailing address

443 LAUREL OAK RD SUITE 130
VOORHEES NJ
08043-4419
US

V. Phone/Fax

Practice location:
  • Phone: 856-741-0122
  • Fax:
Mailing address:
  • Phone: 856-741-0122
  • Fax: 856-741-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00184300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA001918L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: