Provider Demographics
NPI:1003078171
Name:CLARKE, ALEXANDERA K (PA)
Entity Type:Individual
Prefix:
First Name:ALEXANDERA
Middle Name:K
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLUMBUS CIRCLE
Mailing Address - Street 2:FL 8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1412
Mailing Address - Country:US
Mailing Address - Phone:212-664-9323
Mailing Address - Fax:212-664-9341
Practice Address - Street 1:420 FRONT STREET
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2177
Practice Address - Country:US
Practice Address - Phone:856-358-1500
Practice Address - Fax:856-358-1117
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012576363AS0400X
NY0125761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical