Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA09966500 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A124762 | CA |
NPI | 1154580751 |
---|---|
Provider Name | Dr. Matthew Theys Kleiner |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 21/05/2019 |