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General NPI Number Information
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NPI Number | 1396947073
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Entity Type | Organization
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Legal Business Name | CLEMENSEN FAMILY MEDICINE
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 181 S MAIN ST SUITE 5
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1911
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Country | US
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Telephone | 866-269-4810
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Fax | 866-269-4810
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Provider Business Mailing Address
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Address Line | 255 BRISTOL ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1656
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Country | US
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Telephone | 866-269-4810
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT ERIK CLEMENSEN
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Credential | MD
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Telephone | 866-269-4810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 228650
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License Number State | NY
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