Active NPI
Tara Annette Clark, M.S.
- Specialist
- Hicksville, NY
National Provider Identifier
1013270917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1711977
- Practice address
- 24 Libby Ave
Hicksville, NY 11801-1737 - Phone
- (516) 495-4196
- NPI assigned
- Jun 17, 2012
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1711977 | NY | Primary |
Addresses
Primary practice location
24 Libby Ave
Hicksville, NY 11801-1737
Mailing address
24 Libby Ave
Hicksville, NY 11801-1737
Phone (516) 495-4196
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1711977 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339891200000",
"number": "1013270917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 LIBBY AVE",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118011737",
"telephone_number": "516-495-4196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 LIBBY AVE",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118011737",
"telephone_number": "516-495-4196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TARA",
"middle_name": "ANNETTE",
"name_prefix": "Mrs.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-17",
"last_updated": "2012-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1711977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hicksville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.