=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205781044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARKE CENTER COMMUNITY OPTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2026
-----------------------------------------------------
Last Update Date | 02/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 158 MADISON AVE
-----------------------------------------------------
City | IRVINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07111-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-412-1084
-----------------------------------------------------
Fax | 347-718-5864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 SHEPHERD AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11208-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-412-1084
-----------------------------------------------------
Fax | 347-718-5864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GERSHON E CLARKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-412-1084
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------