Provider Demographics
NPI:1043080484
Name:CLAY, MIATA
Entity Type:Individual
Prefix:
First Name:MIATA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SEAPORT DR APT A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-3385
Mailing Address - Country:US
Mailing Address - Phone:917-485-4426
Mailing Address - Fax:
Practice Address - Street 1:708 SEAPORT DR APT A
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-3385
Practice Address - Country:US
Practice Address - Phone:917-485-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport