Basic Information
| Provider Information | |||||||||
| NPI: | 1629412390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGMANN | ||||||||
| FirstName: | CLARA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 82 MINNA ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112182116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089426813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 PALMER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONXVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107083403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147875000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 303034 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 294389-01 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 294389-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05032076 | 05 | MS | MEDICAID | 2332651 | 05 | LA | MEDICAID |