Provider Demographics
NPI:1346238565
Name:KLINGBEIL, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:KLINGBEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 WEST 168TH STREET
Mailing Address - Street 2:#38
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-4593
Mailing Address - Fax:212-342-6852
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3735
Practice Address - Country:US
Practice Address - Phone:212-305-4593
Practice Address - Fax:212-342-6852
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07919400207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909699Medicaid
NJ0072371Medicaid
E85554Medicare UPIN
NY49C33XVTR1Medicare PIN
NJ092846Medicare ID - Type Unspecified