Provider Demographics
NPI:1043395429
Name:CLARICK, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:CLARICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 188TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5001
Mailing Address - Country:US
Mailing Address - Phone:718-563-0757
Mailing Address - Fax:718-563-0756
Practice Address - Street 1:105 W 188TH ST.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5001
Practice Address - Country:US
Practice Address - Phone:718-563-0757
Practice Address - Fax:718-563-0756
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02093694Medicaid
NY02093694Medicaid