Basic Information
| Provider Information | |||||||||
| NPI: | 1114929635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLAFTER | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 663 PALISADE AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013131933 | ||||||||
| FaxNumber: | 2013139599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 25MA03050000 | NJ | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1380401 | 05 | NJ | MEDICAID | 2355993 | 01 | NJ | AETNA HMO # | OTHER | 12885 | 01 | NJ | UNIVERSITY HEALTH PLANS | OTHER | 1K3403 | 01 | NJ | HEALTHNET # | OTHER | BS681 | 01 | NJ | OXFORD # | OTHER | 62T001 | 01 | NJ | EMPIRE BC/BS (ENGLEWOOD) | OTHER | 8214153 | 01 | NJ | GHI PPO | OTHER | 00772330 | 05 | NY | MEDICAID | 340017547 | 01 | NJ | RAILROAD MDCR # | OTHER | 62T002 | 01 | NJ | EMPIRE BC/BS (CLIFFSIDE) | OTHER | 1148560 | 01 | NJ | HORIZON NJ HEALTH # | OTHER | 4093057 | 01 | NJ | AETNA PPO # | OTHER |