Provider Demographics
NPI:1043588759
Name:CLEMENTE, CARMINDA
Entity Type:Individual
Prefix:
First Name:CARMINDA
Middle Name:
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EL DORADO DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6407
Mailing Address - Country:US
Mailing Address - Phone:845-300-0459
Mailing Address - Fax:845-735-2695
Practice Address - Street 1:27 EL DORADO DRIVE
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6407
Practice Address - Country:US
Practice Address - Phone:845-300-0459
Practice Address - Fax:845-735-2695
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219891164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse