Healthcare Provider Details

I. General information

NPI: 1902776990
Provider Name (Legal Business Name): IRA KLEIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 SWEET ROSE CT
LAS VEGAS NV
89134-5904
US

IV. Provider business mailing address

102 SHADYSIDE AVE
STATEN ISLAND NY
10309-3517
US

V. Phone/Fax

Practice location:
  • Phone: 718-957-1342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IRA KLEIN
Title or Position: OWNER
Credential: MD
Phone: 201-264-3627