Provider Demographics
NPI:1568431351
Name:MACCIA, CLEMENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:A
Last Name:MACCIA
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 1:65 MOUNTIAN BLVD.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5678
Mailing Address - Country:US
Mailing Address - Phone:732-627-0900
Mailing Address - Fax:732-560-7388
Practice Address - Street 1:65 MOUNTIAN BLVD.
Practice Address - Street 2:SUITE 107
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5678
Practice Address - Country:US
Practice Address - Phone:732-627-0900
Practice Address - Fax:732-560-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02833300174400000X
NJ25MA02833300207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1568431351OtherQUALCARE PPO/HMO
NJ1568431351OtherST. BARNABAS HEALTH
NJ1568431351OtherTRICARE HEALTHNET
NJ7N1821OtherEMPIRE BC
NJP5392984OtherOXFORD
NJ1568431351OtherAMERIHEALTH
NJ01101136OtherAMERIGROUP
NJ1568431351OtherMULTIPLAN PHCS
NJ1568431351OtherCHN
NJ2985900OtherUHC COMMUNITY PLAN
NJ0924679OtherCIGNA, GREATWEST
NJ1568431351OtherHBCBS
NJ5595926OtherAETNA HMO
NJ1568431351OtherUNITED HEATHLCARE
NJ1568431351OtherUS FAMILY
NJ1211058OtherWELLCARE
NJ1555201Medicaid
NJ1568431351OtherCOVENTRY HEALTH-FIRST HEALTH
NJ4238239OtherAETNA PPO
NJ1568431351OtherAMERIHEALTH
NJ1568431351OtherCHN
NJC54143Medicare UPIN