=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104808872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE L KLINE JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 BROWN CT
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07930-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-879-1997
-----------------------------------------------------
Fax | 908-879-6090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 BROWN CT
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07930-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-879-1997
-----------------------------------------------------
Fax | 908-879-6090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 25MA02059200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------