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NPI Code Detail

MEDICARE: ELAINE CLARKE MD

MEDICARE: ELAINE CLARKE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician179996NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1179996POTHERNYHEALTHCARE PARTNERS
2017999601OTHERNYNEIGHBORHOOD
3110403000000OTHERNYFIDELIS CARE
4P4364657OTHERNYUNITEDHEALTH CARE OXFORD
501178778OTHERNYAMERIGROUP

General Provider Information

NPI Number : 1497763171
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE CLARKE MD
Provider Business Mailing Address
First Line : 235 PORT RICHMOND AVENUE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-1701
Country : US
Telephone Number : 718-924-2256
Fax Number : 718-442-0189
Provider Business Practice Location Address
First Line : 235 PORT RICHMOND AVENUE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-1701
Country : US
Telephone Number : 718-924-2256
Fax Number : 718-442-0189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 04/12/2012

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Directions to “ ELAINE CLARKE MD” Practice Location

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