Provider Demographics
NPI:1417919622
Name:CLACHKO, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:CLACHKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-666-3900
Mailing Address - Fax:201-261-0505
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-489-2727
Practice Address - Fax:201-489-5040
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02692200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP333OtherOXFORD PROVIDER NUMBER
BP333OtherOXFORD PROVIDER NUMBER
NJE13558Medicare UPIN