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Individual

CRAIG CLEMENTS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OTR

Contact information

Practice address
825 W END AVE, SUITE 1A, NEW YORK, NY 10025-5349
(845) 564-9853
(845) 564-6974
Mailing address
825 W END AVE, SUITE 1A, NEW YORK, NY 10025-5349
(845) 564-9853
(845) 564-6974

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
008370-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008370-1
OTR LICENSE
NY
Enumeration date
05/03/2007
Last updated
07/08/2007
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