1114929635 NPI number — GEORGE KLAFTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114929635 NPI number — GEORGE KLAFTER

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KLAFTER

Provider First Name:

GEORGE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1114929635

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 DIAMOND HILL RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BERKELEY HEIGHTS

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07922-2104

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

908-273-4300

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

663 PALISADE AVE STE 304

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CLIFFSIDE PARK

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07010-3012

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

201-313-1933

Provider Business Practice Location Address Fax Number:

201-313-9599

Provider Enumeration Date:

08/15/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  25MA03050000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1380401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 2355993 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 12885 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1K3403 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: BS681 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 62T001 . This is a "EMPIRE BC/BS (ENGLEWOOD)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 8214153 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 00772330 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 340017547 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 62T002 . This is a "EMPIRE BC/BS (CLIFFSIDE)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1148560 . This is a "HORIZON NJ HEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 4093057 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".