Provider Demographics
NPI:1811372840
Name:CLARK WARREN ASSOCIATES IN INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CLARK WARREN ASSOCIATES IN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALVATORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-469-7290
Mailing Address - Street 1:65 MOUNTAIN BLVD EXT
Mailing Address - Street 2:209
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2632
Mailing Address - Country:US
Mailing Address - Phone:732-469-7290
Mailing Address - Fax:732-469-7917
Practice Address - Street 1:65 MOUNTAIN BLVD EXT
Practice Address - Street 2:209
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2632
Practice Address - Country:US
Practice Address - Phone:732-469-7290
Practice Address - Fax:732-469-7917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04503700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD-96748Medicare UPIN