East Orange Medical Practice

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA08005400 Issued in NJ

Legal business name

EAST ORANGE MEDICAL PRACTICE

Practice address

108 S Munn Ave
East Orange, NJ 07018-3402

Phone

(973) 674-8100

Fax

(973) 674-8400

NPI assigned

Oct 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert A Clarke, MDNPI 1114934007

Title

Director

Phone

(973) 674-8100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert A Clarke, MD

  • Internal Medicine Physician
  • East Orange, NJ
  • NPI 1114934007
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1114116175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 S MUNN AVE",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070183402",
            "telephone_number": "973-674-8100",
            "fax_number": "973-674-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 S MUNN AVE",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070183402",
            "telephone_number": "973-674-8100",
            "fax_number": "973-674-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ORANGE MEDICAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "973-674-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08005400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Orange General Hospital
• East Orange General Hospital
• East Orange General Hospital
• East Orange General Hospital
• East Orange General Hospital
• East Orange Pharmacy Evergreeen LLC
• East Orange Pharmacy LLC
• East Orange School District
• East Orange Vamc
• East Orange Vamc

• Internal Medicine Physician in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.