Active NPI
Leanna Renee Clark, RDN
- Registered Dietitian
- Brick, NJ
National Provider Identifier
1003505769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86116322
- Practice address
- 321 Herbertsville Road, First Floor
Brick, NJ 08724 - Phone
- (732) 709-7730
- NPI assigned
- May 8, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86116322 | NJ | Primary |
Addresses
Primary practice location
321 Herbertsville Road, First Floor
Brick, NJ 08724
Mailing address
912 Park Place
Red Bank, NJ 07701
Phone (908) 675-3316
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86116322 | NJ | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1003505769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "912 PARK PLACE",
"city": "RED BANK",
"state": "NJ",
"postal_code": "07701",
"telephone_number": "908-675-3316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 HERBERTSVILLE ROAD, FIRST FLOOR",
"city": "BRICK",
"state": "NJ",
"postal_code": "08724",
"telephone_number": "732-709-7730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LEANNA",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NJ",
"license": "86116322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.