Healthcare Provider Details

I. General information

NPI: 1336370493
Provider Name (Legal Business Name): MICHAEL KLEINBURD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 JORALEMON ST 4TH FLOOR
BROOKLYN NY
11201-4312
US

IV. Provider business mailing address

31 NEW DORP LN
STATEN ISLAND NY
10306-2351
US

V. Phone/Fax

Practice location:
  • Phone: 718-643-7116
  • Fax: 718-643-7119
Mailing address:
  • Phone: 718-370-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number031084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: