Healthcare Provider Details

I. General information

NPI: 1588188775
Provider Name (Legal Business Name): JOSEPHINE CLARKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

IV. Provider business mailing address

843 EDWARD ST
NORTH BALDWIN NY
11510-1411
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-0400
  • Fax:
Mailing address:
  • Phone: 718-490-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number402224
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number514226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: