Provider Demographics
NPI:1922014620
Name:BARONE, CLEMENT M (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:M
Last Name:BARONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 YORK AVE
Mailing Address - Street 2:SUITE P-1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2577
Mailing Address - Country:US
Mailing Address - Phone:212-988-1303
Mailing Address - Fax:212-628-9113
Practice Address - Street 1:1440 YORK AVE
Practice Address - Street 2:SUITE P-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2577
Practice Address - Country:US
Practice Address - Phone:212-988-1303
Practice Address - Fax:212-628-9113
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78187Medicare UPIN
NY583391Medicare ID - Type UnspecifiedPROVIDER