Basic Information
Provider Information | |||||||||
NPI: | 1760797385 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BETTY KLEIN, M.D., P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 57 NORTH ST | ||||||||
Address2: | STE. 415 | ||||||||
City: | DANBURY | ||||||||
State: | CT | ||||||||
PostalCode: | 068105660 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037940117 | ||||||||
FaxNumber: | 2037987048 | ||||||||
Practice Location | |||||||||
Address1: | 57 NORTH ST | ||||||||
Address2: | STE. 415 | ||||||||
City: | DANBURY | ||||||||
State: | CT | ||||||||
PostalCode: | 068105660 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037940117 | ||||||||
FaxNumber: | 2037987048 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2010 | ||||||||
LastUpdateDate: | 08/09/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KLEIN | ||||||||
AuthorizedOfficialFirstName: | BETTY | ||||||||
AuthorizedOfficialMiddleName: | R | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2037940117 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 031764 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 1317644 | 05 | CT |   | MEDICAID |