Provider Demographics
NPI:1821391756
Name:JOHN CLEMENTE MD LLC
Entity Type:Organization
Organization Name:JOHN CLEMENTE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-389-0266
Mailing Address - Street 1:164 HIGHWAY 35
Mailing Address - Street 2:SUITE C
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1825
Mailing Address - Country:US
Mailing Address - Phone:732-389-0266
Mailing Address - Fax:732-389-2294
Practice Address - Street 1:164 HIGHWAY 35
Practice Address - Street 2:SUITE C
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1825
Practice Address - Country:US
Practice Address - Phone:732-389-0266
Practice Address - Fax:732-389-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA052589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty