Basic Information
| Provider Information | |||||||||
| NPI: | 1003080623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLECKNER | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 697 | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087540697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005280006 | ||||||||
| FaxNumber: | 7323496030 | ||||||||
| Practice Location | |||||||||
| Address1: | 5501 OLD YORK RD | ||||||||
| Address2: | EINSTEIN MEDICAL CENTER - PHILADELPHIA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566679 | ||||||||
| FaxNumber: | 2154568502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 08/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 247889 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD442848 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.