Healthcare Provider Details

I. General information

NPI: 1417919622
Provider Name (Legal Business Name): MARC A. CLACHKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KINDERKAMACK RD SUITE 300
RIVER EDGE NJ
07661-1939
US

IV. Provider business mailing address

452 OLD HOOK RD 2ND FLOOR
EMERSON NJ
07630-1381
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2727
  • Fax: 201-489-5040
Mailing address:
  • Phone: 201-666-3900
  • Fax: 201-261-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA02692200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: