Provider Demographics
NPI:1255092599
Name:ROBLES, CLEMENTE (MD)
Entity type:Individual
Prefix:
First Name:CLEMENTE
Middle Name:
Last Name:ROBLES
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 1:13732 96TH PL
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2843
Mailing Address - Country:US
Mailing Address - Phone:917-951-1540
Mailing Address - Fax:
Practice Address - Street 1:13732 96TH PL
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2843
Practice Address - Country:US
Practice Address - Phone:917-951-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1093-P.A.207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine