Provider Demographics
NPI:1710988050
Name:CLARKE, DANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:E
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 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:721-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3674
Practice Address - Country:US
Practice Address - Phone:732-442-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06703000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26085OtherUHP NON-PAR#
NJP00603903OtherMEDICARE RAILROAD CARRIER
NJ7502907Medicaid
NJ006976XZ2Medicare PIN
NJ006976AA7Medicare PIN
NJ006976UXKMedicare PIN
NJ006976UWXMedicare PIN
NJ006976DLEMedicare PIN
NJ26085OtherUHP NON-PAR#
NJ006976S6SMedicare PIN
NJ006976SN3Medicare PIN
NJ006976UWYMedicare PIN
NJ006976CLDMedicare PIN
NJ006976P7FMedicare PIN
NJP00603903OtherMEDICARE RAILROAD CARRIER
NJG09887Medicare UPIN