Provider Demographics
NPI:1053604587
Name:HONESTLY&CLEMENCYGENERALAGENCY
Entity type:Organization
Organization Name:HONESTLY&CLEMENCYGENERALAGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FEN
Authorized Official - Middle Name:QIN
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DEALER
Authorized Official - Phone:646-506-8378
Mailing Address - Street 1:6212 23RD AVE
Mailing Address - Street 2:1FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3303
Mailing Address - Country:US
Mailing Address - Phone:646-506-8378
Mailing Address - Fax:212-225-8401
Practice Address - Street 1:6212 23RD AVE
Practice Address - Street 2:1FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3303
Practice Address - Country:US
Practice Address - Phone:646-506-8378
Practice Address - Fax:212-225-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1390146332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTZ55476VMedicaid