Provider Demographics
NPI:1922239094
Name:CLARK, LENORE E (RD)
Entity Type:Individual
Prefix:MRS
First Name:LENORE
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3354
Mailing Address - Country:US
Mailing Address - Phone:732-822-7117
Mailing Address - Fax:732-240-1304
Practice Address - Street 1:129 ROUTE 37 W
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6435
Practice Address - Country:US
Practice Address - Phone:732-822-7117
Practice Address - Fax:732-240-1304
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered