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NPI Code Detail

MEDICARE: ROBERT H CLARK MD PLLC

MEDICARE: ROBERT H CLARK MD PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist144682NY

General Provider Information

NPI Number : 1700825692
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT H CLARK MD PLLC
Provider Business Mailing Address
First Line : 1259 WANTAGH AVE
Second Line :
City : WANTAGH
State : NY
Zip : 11793-2205
Country : US
Telephone Number : 516-221-7971
Fax Number : 516-804-8289
Provider Business Practice Location Address
First Line : 1259 WANTAGH AVE
Second Line :
City : WANTAGH
State : NY
Zip : 11793-2205
Country : US
Telephone Number : 516-221-7971
Fax Number : 516-221-8117
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT HENRY CLARK
Credential : MD
Telephone Number : 516-221-7971
Provider Enumeration Date : 06/06/2006
Last Update Date : 04/14/2014

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