1174665681 NPI number — CLARK INSTITUTE

Table of content: (NPI 1174665681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174665681 NPI number — CLARK INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARK INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174665681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 APPLEWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-4922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-431-1514
Provider Business Mailing Address Fax Number:
609-395-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3303 APPLEWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-4922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-431-1514
Provider Business Practice Location Address Fax Number:
609-395-0120
Provider Enumeration Date:
02/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-431-1514

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  182788 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106486 . This is a "APSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1706 . This is a "APH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83704 . This is a "NAAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 999012391 . This is a "ACH" identifier . This identifiers is of the category "OTHER".