Provider Demographics
NPI:1194764076
Name:KLINOV, VLADIMIR (DC, MD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:KLINOV
Suffix:
Gender:
Credentials:DC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ANISE CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5610
Mailing Address - Country:UM
Mailing Address - Phone:917-318-3773
Mailing Address - Fax:
Practice Address - Street 1:53 NAUTILUS DR STE 201
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2465
Practice Address - Country:US
Practice Address - Phone:609-978-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26MA098892002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4P281Medicare ID - Type Unspecified