Provider Demographics
NPI:1770856684
Name:ACQUAYE, CLEMENT (RN)
Entity Type:Individual
Prefix:MR
First Name:CLEMENT
Middle Name:
Last Name:ACQUAYE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CONCORD AVE
Mailing Address - Street 2:APT. 4L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3139
Mailing Address - Country:US
Mailing Address - Phone:646-302-7087
Mailing Address - Fax:
Practice Address - Street 1:600 CONCORD AVE
Practice Address - Street 2:APT. 4L
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3139
Practice Address - Country:US
Practice Address - Phone:646-302-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649876-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse