Provider Demographics
NPI:1669471785
Name:KLEMMT, MARCUS FRANK (CPO, FAAOP)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:FRANK
Last Name:KLEMMT
Suffix:
Gender:M
Credentials:CPO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 OAKDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-770-4400
Mailing Address - Fax:607-770-4422
Practice Address - Street 1:130 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1758
Practice Address - Country:US
Practice Address - Phone:607-770-4400
Practice Address - Fax:607-770-4422
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00432504Medicaid
NY0237740001Medicare ID - Type UnspecifiedPROVIDER #