Provider Demographics
NPI:1043599384
Name:CLARKE, ALBERT G
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:G
Last Name:CLARKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 WEST AVE
Mailing Address - Street 2:APT. 6E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7349
Mailing Address - Country:US
Mailing Address - Phone:727-430-4859
Mailing Address - Fax:
Practice Address - Street 1:1470 WEST AVE
Practice Address - Street 2:APT. 6E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7349
Practice Address - Country:US
Practice Address - Phone:727-430-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305725164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse