Provider Demographics
NPI:1871732172
Name:ROBINSON, CLINCY SR
Entity type:Individual
Prefix:MR
First Name:CLINCY
Middle Name:
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CLINCY
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:231 THROOP AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5706
Mailing Address - Country:US
Mailing Address - Phone:718-443-4368
Mailing Address - Fax:
Practice Address - Street 1:231 THROOP AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5706
Practice Address - Country:US
Practice Address - Phone:718-443-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215502164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse