Provider Demographics
NPI:1770444374
Name:CLINTON, DARRIC
Entity type:Individual
Prefix:
First Name:DARRIC
Middle Name:
Last Name:CLINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 5TH AVE APT 13H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1025
Mailing Address - Country:US
Mailing Address - Phone:718-419-7049
Mailing Address - Fax:
Practice Address - Street 1:1345 5TH AVE APT 13H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1025
Practice Address - Country:US
Practice Address - Phone:718-419-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC4947175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty