Provider Demographics
NPI:1730482928
Name:CLEMENTE, RICHARD HEBREZA (ACNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HEBREZA
Last Name:CLEMENTE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 44TH DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4750
Mailing Address - Country:US
Mailing Address - Phone:917-456-2393
Mailing Address - Fax:
Practice Address - Street 1:530 FIRST AVENUE, HCC 13
Practice Address - Street 2:NYU LANGONE MEDICAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1753
Practice Address - Country:US
Practice Address - Phone:347-346-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520383163WC0200X
NYF430528-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine