Healthcare Provider Details

I. General information

NPI: 1730592957
Provider Name (Legal Business Name): KAREN A CLARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 CRANBURY RD
EAST BRUNSWICK NJ
08816-3610
US

IV. Provider business mailing address

579A CRANBURY RD
EAST BRUNSWICK NJ
08816-5426
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-0040
  • Fax: 732-955-8874
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-955-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA10785300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: