Provider Demographics
NPI:1689665358
Name:CLARKE, JAMES ALOYSIUS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALOYSIUS
Last Name:CLARKE
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 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-785-1000
Mailing Address - Fax:732-785-1222
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-785-1000
Practice Address - Fax:732-785-1222
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04581300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ174910201Medicaid
NJD90485Medicare UPIN
NJ582194P6RMedicare PIN
NJ080178927Medicare PIN