Provider Demographics
NPI:1487048906
Name:KLAUSNER, MOSHE (MD)
Entity type:Individual
Prefix:MR
First Name:MOSHE
Middle Name:
Last Name:KLAUSNER
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 1:1029 PLEASANT STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:508-697-8116
Mailing Address - Fax:508-697-8117
Practice Address - Street 1:1029 PLEASANT STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:508-697-8116
Practice Address - Fax:508-697-8117
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA274092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081872AMedicaid