Provider Demographics
NPI:1184939985
Name:KLEINMAN, SHANON J (MD)
Entity type:Individual
Prefix:
First Name:SHANON
Middle Name:J
Last Name:KLEINMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-0724
Mailing Address - Country:US
Mailing Address - Phone:973-660-9334
Mailing Address - Fax:973-660-9779
Practice Address - Street 1:61 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4205
Practice Address - Country:US
Practice Address - Phone:212-367-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08705400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241156Medicaid
NY254479OtherLICENSE