Provider Demographics
NPI:1477505147
Name:LEFEVRE, CLUNY (DO)
Entity type:Individual
Prefix:
First Name:CLUNY
Middle Name:
Last Name:LEFEVRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 FORT WASHINGTON AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3522
Mailing Address - Country:US
Mailing Address - Phone:212-740-4600
Mailing Address - Fax:212-740-4604
Practice Address - Street 1:427 FORT WASHINGTON AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3522
Practice Address - Country:US
Practice Address - Phone:212-740-4600
Practice Address - Fax:212-740-4604
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205008-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01863116Medicaid
NYG79015Medicare UPIN
NY32V802Medicare ID - Type Unspecified