Provider Demographics
NPI:1396947073
Name:CLEMENSEN FAMILY MEDICINE
Entity type:Organization
Organization Name:CLEMENSEN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:CLEMENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-269-4810
Mailing Address - Street 1:255 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1656
Mailing Address - Country:US
Mailing Address - Phone:866-269-4810
Mailing Address - Fax:
Practice Address - Street 1:181 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1911
Practice Address - Country:US
Practice Address - Phone:866-269-4810
Practice Address - Fax:866-269-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228650261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care