Provider Demographics
NPI:1699012302
Name:CLEMENS, STEPHANIE GARRETT (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GARRETT
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W 23RD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2410
Mailing Address - Country:US
Mailing Address - Phone:424-347-6299
Mailing Address - Fax:
Practice Address - Street 1:116 W 23RD ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2410
Practice Address - Country:US
Practice Address - Phone:424-347-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36153261207R00000X
NV15880207R00000X
GA83470207R00000X
ALMD.40853207R00000X
SC82381207R00000X
VA101267322207R00000X
WAMD61079459207R00000X
KY52617207R00000X
NC2019-01297207R00000X
NY299269207R00000X
OH35.136453207R00000X
WI860-320207R00000X
MDD0090712207R00000X
TND0090712207R00000X
MI4301111211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13578144OtherCAQH