Healthcare Provider Details

I. General information

NPI: 1609088806
Provider Name (Legal Business Name): GENNA WALDMAN KLEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE CHAM
BRONX NY
10467-2403
US

IV. Provider business mailing address

111 E 210TH ST CHILDREN'S HOSPITAL AT MONTEFIORE
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4664
  • Fax:
Mailing address:
  • Phone: 718-920-4664
  • Fax: 718-405-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226697
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number226697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: