Active NPI
Christine Clark
- Family Nurse Practitioner
- New York, NY
National Provider Identifier
1548876097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 346641
- Practice address
- 1440 Broadway
New York, NY 10018-2301 - Phone
- (866) 389-2727
- NPI assigned
- Sep 21, 2020
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 346641 | NY | Primary |
Addresses
Primary practice location
1440 Broadway
New York, NY 10018-2301
Mailing address
1440 Broadway
New York, NY 10018-2301
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 346641 | NY | MD | Family Nurse Practitioner |
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600646400000",
"number": "1548876097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100182301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100182301",
"telephone_number": "866-389-2727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-21",
"last_updated": "2020-09-21",
"certification_date": "2020-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "346641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.