Basic Information
| Provider Information | |||||||||
| NPI: | 1265434005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3998 FAIR RIDGE DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220332921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032959360 | ||||||||
| FaxNumber: | 7037669725 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 SECOND AVENUE | ||||||||
| Address2: | MONMOUTH MEDICAL CENTER | ||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322225200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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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 | 207L00000X | 220847 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA08254500 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0159735 | 05 | NJ | MEDICAID | 02166250 | 05 | NY | MEDICAID | 050089962 | 01 | NY | RAILROAD MEDICARE | OTHER | CE9959 | 01 | NY | RAILROAD MEDICARE GROUP | OTHER | 7L8201 | 01 | NY | EMPIRE MEDICARE | OTHER |