Provider Demographics
NPI:1104932144
Name:KLOS, ANDRZEJ EDMUND (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:EDMUND
Last Name:KLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODCREST CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5828
Mailing Address - Country:US
Mailing Address - Phone:908-755-9467
Mailing Address - Fax:908-756-7098
Practice Address - Street 1:1327 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3337
Practice Address - Country:US
Practice Address - Phone:201-963-5633
Practice Address - Fax:201-963-5412
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06004500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K8654OtherHEALTHNET
NJ81849OtherAMERIGROUP
0005778469OtherAETNA
446X31OtherEMPIRE BCBS
9847708014OtherCIGNA HEALTHCARE
P1244524OtherOXFORD HEALTH PLANS
NJ6201407Medicaid
1852641OtherUNITED HEALTHCARE
0005778469OtherAETNA
NJ81849OtherAMERIGROUP