Healthcare Provider Details

I. General information

NPI: 1659288058
Provider Name (Legal Business Name): MARLEE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

1405 LONG BEACH BLVD
LONG BEACH TOWNSHIP NJ
08008-2250
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number26NR21600500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ15638400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: