| Doctor Name: | CLEMENTINO PURISIMA |
| NPI Number: | 1144354788 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MA03503500 |
| Business Practice Address: | 1005 New York Ave Union City, NJ - 070874127 |
| Business Phone Number: | 2018635065 |
| Business Fax Number: | 2019341383 |
| Mailing Address: | 41 Gristmill Ln, UPPER SADDLE RIVER |
| State: | NJ |
| Postal Code: | 074581316 |
| Phone Number: | 2018635065 |
| Fax Number: | 2019341383 |
| NPI Enumeration Date: | 03/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MA03503500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |