Provider Demographics
NPI:1932524188
Name:CLEMENTE ORTHODONTICS OF NEW YORK PC
Entity Type:Organization
Organization Name:CLEMENTE ORTHODONTICS OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNATTASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-638-6646
Mailing Address - Street 1:603 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2919
Mailing Address - Country:US
Mailing Address - Phone:845-638-6646
Mailing Address - Fax:845-638-6696
Practice Address - Street 1:603 ROUTE 304
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2919
Practice Address - Country:US
Practice Address - Phone:845-638-6646
Practice Address - Fax:845-638-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0293661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty