Provider Demographics
NPI:1932141108
Name:CLEMENTE, MARIA F (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1458
Mailing Address - Country:US
Mailing Address - Phone:732-264-3937
Mailing Address - Fax:732-264-1311
Practice Address - Street 1:82 BETHANY RD
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1458
Practice Address - Country:US
Practice Address - Phone:732-264-3937
Practice Address - Fax:732-264-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6031501Medicaid
NE084450Medicare ID - Type Unspecified
NJF71221Medicare UPIN