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General NPI Number Information
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NPI Number | 1891210407
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Entity Type | Individual
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Provider Name | ALEXANDRA CLEMINSON
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Gender | Female
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 205 E 64TH ST STE 101
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City | NEW YORK
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State | NY
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Zip | 10065-6673
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Country | US
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Telephone | 212-888-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 319 E 78TH ST APT 2A
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City | NEW YORK
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State | NY
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Zip | 10075-9007
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Country | US
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Telephone | 617-840-2733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 08676
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License Number State | NY
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