Healthcare Provider Details

I. General information

NPI: 1326123787
Provider Name (Legal Business Name): PETER R KLAINBARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG - CO-OP CITY 2100 BARTOW AVENUE, STE. 311
BRONX NY
10475
US

IV. Provider business mailing address

2100 BARTOW AVE SUITE 311
BRONX NY
10475-4614
US

V. Phone/Fax

Practice location:
  • Phone: 718-320-5300
  • Fax:
Mailing address:
  • Phone: 718-320-5300
  • Fax: 718-320-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number129389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: