Provider Demographics
NPI:1881801231
Name:CLARK, MONICA RIELY (PA-C)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:RIELY
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:NEALE
Other - Last Name:RIELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2006 HIGHWAY 71 STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2283
Mailing Address - Country:US
Mailing Address - Phone:732-282-8166
Mailing Address - Fax:732-280-0147
Practice Address - Street 1:2006 HIGHWAY 71 STE 3
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2283
Practice Address - Country:US
Practice Address - Phone:732-282-8166
Practice Address - Fax:732-280-0147
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00185600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant