Provider Demographics
NPI:1154429082
Name:KLEIN, LARRY HAROLD (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:HAROLD
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 BRIGHTON 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5327
Mailing Address - Country:US
Mailing Address - Phone:718-332-6262
Mailing Address - Fax:718-332-3216
Practice Address - Street 1:172 BRIGHTON 11TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-332-6262
Practice Address - Fax:718-332-3216
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002382213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405725Medicaid
NY00405725Medicaid
T50755Medicare UPIN