Healthcare Provider Details

I. General information

NPI: 1245288711
Provider Name (Legal Business Name): CLARA E LENGYEL-KREMENIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 N OCEAN AVE
MEDFORD NY
11763-2649
US

IV. Provider business mailing address

1723 N OCEAN AVE
MEDFORD NY
11763-2649
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-5858
  • Fax: 631-447-6372
Mailing address:
  • Phone: 631-758-5858
  • Fax: 631-447-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number222585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: