Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA07919400 | NJ |
NPI | 1346238565 |
---|---|
Provider Name | Heidi Klingbeil |
First Address | New York, NY 10032 |
Second Address | New York, NY 10032-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072371 | (05) | NJ |
02909699 | (05) | NY |
E85554 | (02) |