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NPI Code Detail

MEDICARE: CLARENDON MEDICAL PC

MEDICARE: CLARENDON MEDICAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician123637NY

General Provider Information

NPI Number : 1952608986
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARENDON MEDICAL PC
Provider Business Mailing Address
First Line : 2814 CLARENDON RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6318
Country : US
Telephone Number : 718-469-7363
Fax Number : 718-469-7551
Provider Business Practice Location Address
First Line : 2814 CLARENDON RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-6318
Country : US
Telephone Number : 718-469-7363
Fax Number : 718-469-7551
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : ERNESTO LOPEZ
Credential : MD
Telephone Number : 718-469-7363
Provider Enumeration Date : 02/28/2011
Last Update Date : 02/28/2011

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Directions to “CLARENDON MEDICAL PC ” Practice Location

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