MEDICARE: DR. KATHERINE KLEBAN AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	41YA00089100	NJ

General Provider Information

NPI Number	:	1154723898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE KLEBAN AU.D.

Provider Business Mailing Address
First Line	:	690 KINDERKAMACK RD STE 101
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 KINDERKAMACK RD STE 101
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-722-9850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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