Provider Demographics
NPI:1891760633
Name:CLARK, DENISE CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:CAROLINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W 76TH ST
Mailing Address - Street 2:#3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8713
Mailing Address - Country:US
Mailing Address - Phone:917-441-1487
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-8950
Practice Address - Fax:860-545-8959
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2215372080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01993140Medicaid
NYG96509Medicare UPIN
NY01993140Medicaid