Provider Demographics
NPI:1235318387
Name:ALAN B. CLARK M.D, P.A.
Entity Type:Organization
Organization Name:ALAN B. CLARK M.D, P.A.
Other - Org Name:RUTH L. CLARK
Other - Org Type:Other Name
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BUTLER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:973-678-5607
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE#303
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-678-5607
Mailing Address - Fax:973-678-6319
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:SUITE#611
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3332
Practice Address - Country:US
Practice Address - Phone:973-678-5607
Practice Address - Fax:973-678-6319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN B. CLARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA20681174400000X
NJMA56498282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty