MEDICARE: PKCLEMENS ENTERPRISES LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1700386950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PKCLEMENS ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1542 KUSER RD STE B4
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3829
Country	:	US
Telephone Number	:	609-557-3350
Fax Number	:	609-981-7039

Provider Business Practice Location Address
First Line	:	1542 KUSER RD STE B4
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3829
Country	:	US
Telephone Number	:	609-557-3350
Fax Number	:	609-981-7039

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEAN-PAUL CLEMENS
Credential	:
Telephone Number	:	609-902-2366

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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