Healthcare Provider Details

I. General information

NPI: 1851562425
Provider Name (Legal Business Name): CLARK DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CENTRAL AVE
CLARK NJ
07066-1116
US

IV. Provider business mailing address

469 MORRIS AVE STE 3
ELIZABETH NJ
07208-2904
US

V. Phone/Fax

Practice location:
  • Phone: 732-574-1399
  • Fax: 732-574-1433
Mailing address:
  • Phone: 732-574-1399
  • Fax: 908-512-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER DOCTOROFF
Title or Position: OWNER
Credential: D.O.
Phone: 732-574-1399