Active NPI
John Kleback, MD
- Pediatrics Physician
- Willow Grove, PA
National Provider Identifier
1184629255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD417358
- Practice address
- 2510 Maryland Rd
Suite 160
Willow Grove, PA 19090-1109 - Phone
- (215) 672-6622
- Fax
- (215) 672-6566
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD417358 | PA | Primary |
Addresses
Primary practice location
2510 Maryland Rd
Suite 160
Willow Grove, PA 19090-1109
Mailing address
2510 Maryland Rd
Suite 160
Willow Grove, PA 19090-1109
Phone (215) 672-6622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD417358 | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| True North Medical Group, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280880000000",
"number": "1184629255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2510 MARYLAND RD",
"address_2": "SUITE 160",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901109",
"telephone_number": "215-672-6622",
"fax_number": "215-672-6566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2510 MARYLAND RD",
"address_2": "SUITE 160",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901109",
"telephone_number": "215-672-6622",
"fax_number": "215-672-6566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEBACK",
"first_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2010-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD417358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.