Provider Demographics
NPI:1013937648
Name:CLEMENS, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:CLEMENS
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 1:3160 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4520
Mailing Address - Country:US
Mailing Address - Phone:718-932-2110
Mailing Address - Fax:718-274-6945
Practice Address - Street 1:3160 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4520
Practice Address - Country:US
Practice Address - Phone:718-932-2110
Practice Address - Fax:718-274-6945
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01847805Medicaid
NYG400010711Medicare PIN
NY543401Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER