Provider Demographics
NPI:1619743739
Name:DEDEUS, CLENIO
Entity Type:Individual
Prefix:
First Name:CLENIO
Middle Name:
Last Name:DEDEUS
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 1:7 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3706
Mailing Address - Country:US
Mailing Address - Phone:908-675-1433
Mailing Address - Fax:
Practice Address - Street 1:251 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7090
Practice Address - Country:US
Practice Address - Phone:908-675-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport