Provider Demographics
NPI:1588923957
Name:CLEMENTE, FERNANDO M (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:M
Last Name:CLEMENTE
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 1:12 E 86TH ST
Mailing Address - Street 2:APT. 908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0506
Mailing Address - Country:US
Mailing Address - Phone:212-535-2675
Mailing Address - Fax:
Practice Address - Street 1:12 E 86TH ST
Practice Address - Street 2:APT. 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0506
Practice Address - Country:US
Practice Address - Phone:212-535-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist