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General NPI Number Information
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NPI Number | 1831388263
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Entity Type | Organization
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Legal Business Name | CHARLES C.KLEINBERG
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 109-33 71ST ROAD APT 1F
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City | FOREST HILLS
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State | NY
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Zip | 11375-4813
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Country | US
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Telephone | 718-575-2930
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10028-0934
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Country | US
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Telephone | 212-288-1399
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. CHARLES C KLEINBERG
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Credential | M.D
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Telephone | 212-288-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 127745
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License Number State | NY
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