Provider Demographics
NPI:1942883228
Name:CLERZIAS, KERLINE
Entity Type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:CLERZIAS
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 1:431 BEACH 63RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1420
Mailing Address - Country:US
Mailing Address - Phone:646-200-1664
Mailing Address - Fax:
Practice Address - Street 1:431 BEACH 63RD ST FL 2
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1420
Practice Address - Country:US
Practice Address - Phone:646-200-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33978001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty