Provider Demographics
NPI:1174670889
Name:KLINGER M.D. AND MISRA M.D. PTR
Entity type:Organization
Organization Name:KLINGER M.D. AND MISRA M.D. PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-541-0300
Mailing Address - Street 1:880 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2351
Mailing Address - Country:US
Mailing Address - Phone:516-541-0300
Mailing Address - Fax:516-541-6390
Practice Address - Street 1:880 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2351
Practice Address - Country:US
Practice Address - Phone:516-541-0300
Practice Address - Fax:516-541-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189741174400000X
NY227038174400000X
NY160815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF38368Medicare UPIN
NYH99980Medicare UPIN
NYA64516Medicare UPIN
NYWAW921Medicare PIN