MEDICARE: CHRISTOPHER CLEMENS M.D.

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
1	208000000X	Pediatrics Physician	207232	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013937648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER CLEMENS M.D.

Provider Business Mailing Address
First Line	:	3160 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4520
Country	:	US
Telephone Number	:	718-932-2110
Fax Number	:	718-274-6945

Provider Business Practice Location Address
First Line	:	3160 21ST ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4520
Country	:	US
Telephone Number	:	718-932-2110
Fax Number	:	718-274-6945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/09/2010

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