Provider Demographics
NPI:1659447605
Name:CLEMENTE, JOSE ANTONIO
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:CLEMENTE
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 1:24 METROPOLITAN OVAL
Mailing Address - Street 2:4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6722
Mailing Address - Country:US
Mailing Address - Phone:646-294-3174
Mailing Address - Fax:
Practice Address - Street 1:549 W 180TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5825
Practice Address - Country:US
Practice Address - Phone:212-795-9888
Practice Address - Fax:212-795-9899
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator