Provider Demographics
NPI:1053360578
Name:KLEIN, ANN S (RD CDE)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:S
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3332
Mailing Address - Country:US
Mailing Address - Phone:716-675-3754
Mailing Address - Fax:716-675-7110
Practice Address - Street 1:1900 RIDGE ROAD
Practice Address - Street 2:MEDICAL ASSOCIATES SOUTHTOWNS PC
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-675-3754
Practice Address - Fax:716-675-7110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002074207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
6511050OtherIHA
0052749501OtherBC & BS OF WNY
DD2620Medicare ID - Type Unspecified