Provider Demographics
NPI:1487704573
Name:KLEIN, MITCHELL L (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:KLEIN
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 1:65 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1641
Mailing Address - Country:US
Mailing Address - Phone:845-942-0283
Mailing Address - Fax:845-942-0389
Practice Address - Street 1:65 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1641
Practice Address - Country:US
Practice Address - Phone:845-942-0283
Practice Address - Fax:845-942-0389
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00755037Medicaid
NYRP171OtherOXFORD
NY17244OtherGHI
NYRP171OtherOXFORD