MEDICARE: CARMINDA CLEMENTE

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	164W00000X	Licensed Practical Nurse	219891	NY

General Provider Information

NPI Number	:	1043588759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMINDA CLEMENTE

Provider Business Mailing Address
First Line	:	27 EL DORADO DRIVE
Second Line	:
City	:	CHESTNUT RIDGE
State	:	NY
Zip	:	10977-6407
Country	:	US
Telephone Number	:	845-300-0459
Fax Number	:	845-735-2695

Provider Business Practice Location Address
First Line	:	27 EL DORADO DRIVE
Second Line	:
City	:	CHESTNUT RIDGE
State	:	NY
Zip	:	10977-6407
Country	:	US
Telephone Number	:	845-300-0459
Fax Number	:	845-735-2695

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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