Basic Information
| Provider Information | |||||||||
| NPI: | 1528327707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 WALKER ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122268866 | ||||||||
| FaxNumber: | 2122262289 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100133599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123796998 | ||||||||
| FaxNumber: | 2123796930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 654580 | NY | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 308707 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 03511653 | 05 | NY | MEDICAID |