Healthcare Provider Details

I. General information

NPI: 1174670889
Provider Name (Legal Business Name): KLINGER M.D. AND MISRA M.D. PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N BROADWAY
MASSAPEQUA NY
11758-2351
US

IV. Provider business mailing address

880 N BROADWAY
MASSAPEQUA NY
11758-2351
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-0300
  • Fax: 516-541-6390
Mailing address:
  • Phone: 516-541-0300
  • Fax: 516-541-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number189741
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number227038
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number160815
License Number StateNY

VIII. Authorized Official

Name: DR. RONALD F KLINGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-541-0300