Healthcare Provider Details

I. General information

NPI: 1346238565
Provider Name (Legal Business Name): HEIDI KLINGBEIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE SUITE 199
NEW YORK NY
10032-3735
US

IV. Provider business mailing address

630 WEST 168TH STREET #38
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4593
  • Fax: 212-342-6852
Mailing address:
  • Phone: 212-305-4593
  • Fax: 212-342-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA07919400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: