Provider Demographics
NPI:1720471592
Name:CLOVER HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLOVER HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEKTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-416-3717
Mailing Address - Street 1:3 2ND ST
Mailing Address - Street 2:HARBORSIDE PLAZA 10
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3099
Mailing Address - Country:US
Mailing Address - Phone:201-416-3717
Mailing Address - Fax:732-384-3773
Practice Address - Street 1:3 2ND ST
Practice Address - Street 2:HARBORSIDE PLAZA 10
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3099
Practice Address - Country:US
Practice Address - Phone:201-416-3717
Practice Address - Fax:732-384-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty