Provider Demographics
NPI:1023369741
Name:VOGEL, CLARISSA BARBON (PPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:BARBON
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PPCNP-BC
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Other - Credentials:
Mailing Address - Street 1:13-17 SAMPSON RD
Mailing Address - Street 2:APT B
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-7300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-3281
Practice Address - Fax:212-342-2851
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2016-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR14057000363LP0200X
NYF382250-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics