Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DI016477 | NJ |
N | 1223P0300X | Periodontist | DS026054L | PA |
NPI | 1104963206 |
---|---|
Provider Name | Dr. Edward Martin Klinger |
First Address | Moorestown, NJ 08057-3849 |
Second Address | Westmont, NJ 08108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |