Basic Information
| Provider Information | |||||||||
| NPI: | 1639424617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEINBERG | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SW 87TH AVENUE | ||||||||
| Address2: | C-350 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547319676 | ||||||||
| FaxNumber: | 9547319747 | ||||||||
| Practice Location | |||||||||
| Address1: | 4701 N. FEDERAL HWY | ||||||||
| Address2: | #370 | ||||||||
| City: | POPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330646874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549415731 | ||||||||
| FaxNumber: | 9549412706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 02/25/2016 | ||||||||
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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 | 208000000X | ME119724 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 012380000 | 05 | FL | MEDICAID |