Provider Demographics
NPI:1881118578
Name:KLOCK, CLARA LUCIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:LUCIA
Last Name:KLOCK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 WEEKS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7005
Mailing Address - Country:US
Mailing Address - Phone:718-583-6000
Mailing Address - Fax:718-731-0631
Practice Address - Street 1:1691 WEEKS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7005
Practice Address - Country:US
Practice Address - Phone:718-583-6000
Practice Address - Fax:718-731-0631
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488087163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY488087Medicaid