Provider Demographics
NPI:1255718276
Name:CLARE MEDICAL OF NEW JERSEY LLC
Entity type:Organization
Organization Name:CLARE MEDICAL OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-684-1616
Mailing Address - Street 1:137 HIGH ST FL 2A
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1476
Mailing Address - Country:US
Mailing Address - Phone:609-474-0120
Mailing Address - Fax:844-772-0852
Practice Address - Street 1:137 HIGH ST FL 2A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1476
Practice Address - Country:US
Practice Address - Phone:609-474-0120
Practice Address - Fax:844-772-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 363LG0600X, 207P00000X, 207Q00000X, 363LG0600X
NJ363L00000X, 207QG0300X, 363L00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0479527Medicaid
NJ0479527Medicaid