Healthcare Provider Details

I. General information

NPI: 1790787653
Provider Name (Legal Business Name): DAVID MARC KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 12TH AVE
BROOKLYN NY
11219-1094
US

IV. Provider business mailing address

1248 WATERVIEW ST
FAR ROCKAWAY NY
11691-1743
US

V. Phone/Fax

Practice location:
  • Phone: 718-438-4400
  • Fax: 718-438-4404
Mailing address:
  • Phone: 718-868-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: