Provider Demographics
NPI:1386788792
Name:KLENOFF, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KLENOFF
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 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:EAR, NOSE, & THROAT CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-353-0000
Mailing Address - Fax:203-357-8109
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:EAR, NOSE, & THROAT CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-353-0000
Practice Address - Fax:203-357-8109
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041345207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85526Medicare UPIN