Provider Demographics
NPI:1740349968
Name:CLARK-BROWN, RUTH LYNNE (MD)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:LYNNE
Last Name:CLARK-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:L
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:240 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-674-3500
Mailing Address - Fax:973-678-6319
Practice Address - Street 1:240 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-674-3500
Practice Address - Fax:973-678-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56498174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135853OtherMEDICARE GROUP
NJ280330501OtherMEDICAID GROUP
NJ5069408Medicaid
NJ5069408Medicaid
NJ280330501OtherMEDICAID GROUP