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General NPI Number Information
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NPI Number | 1609365352
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Entity Type | Individual
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Provider Name | ANDREW THOMAS CLARK FNP-BC, DNP
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Gender | Male
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 1270 AVENUE OF THE AMERICAS STE 757
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City | NEW YORK
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State | NY
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Zip | 10020-1700
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Country | US
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Telephone | 646-248-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 137 DARK HOLLOW RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 343027
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 690785
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License Number State | NY
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