Provider Demographics
NPI:1558462044
Name:PHILOGENE, CLARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:E
Last Name:PHILOGENE
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 1:2401 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5745
Mailing Address - Country:US
Mailing Address - Phone:908-688-5000
Mailing Address - Fax:908-688-5220
Practice Address - Street 1:2401 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5745
Practice Address - Country:US
Practice Address - Phone:908-688-5000
Practice Address - Fax:908-688-5220
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ766909Medicaid
NJ766909Medicaid