Physician Compare National (NPI:1053405654)

HEALTHCARE PROVIDER: RODERICK JOHN CLEMENTE M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1053405654
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234125030
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040426000064
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLEMENTE
	Individual professional last name
Provider First Name	RODERICK
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NEUROSURGICAL CARE OF NEW JERSEY, P.A.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7315920642
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	96 GATES AVE
	Group Practice or individual's line 1 address
City	MONTCLAIR
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	070422501
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9737443166
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	310054
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HACKENSACKUMC MOUNTAINSIDE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	310009
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CLARA MAASS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y