Active NPI
Ondrea Clark
- Specialist
- Watertown, NY
National Provider Identifier
1053712430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1173386
- Practice address
- 21638 Reed Rd
Watertown, NY 13601-5048 - Phone
- (315) 786-0677
- NPI assigned
- Sep 4, 2014
- Last updated
- Sep 4, 2014
- 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 | 1173386 | NY | Primary |
Addresses
Primary practice location
21638 Reed Rd
Watertown, NY 13601-5048
Mailing address
556 County Route 5
Pulaski, NY 13142-2217
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 |
|---|---|---|---|
| 1173386 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Building Blocks SLP, OT & PT Family Services, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Early Intervention Provider Agency
- Watertown, NY
- NPI 1760635205
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409788800000",
"number": "1053712430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 COUNTY ROUTE 5",
"city": "PULASKI",
"state": "NY",
"postal_code": "131422217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21638 REED RD",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136015048",
"telephone_number": "315-786-0677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ONDREA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-04",
"last_updated": "2014-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1173386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.