Provider Demographics
NPI:1376801340
Name:MORGAN, CLINTON GEORGE (RN)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:GEORGE
Last Name:MORGAN
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 1:538 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5716
Mailing Address - Country:US
Mailing Address - Phone:718-774-0300
Mailing Address - Fax:
Practice Address - Street 1:150 ALBANY AVE
Practice Address - Street 2:PAUL ROBESON HIGH SCHOOL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5716
Practice Address - Country:US
Practice Address - Phone:718-774-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY514644-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse