Organization Active NPI

Clinical Practice PC

  • Physician Assistant
  • Newark, NJ
National Provider Identifier
1568829448
Registry record updated Jan 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
CLINICAL PRACTICE PC
Practice address
90 Bergen St
Newark, NJ 07103-2425
Phone
(973) 972-5004
NPI assigned
Jan 22, 2016
Last updated
Jan 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2016

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

Authorized official

Name
Michael J Saulich
Title
Executive Director & Ceo
Phone
(973) 972-5004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

90 Bergen St
Newark, NJ 07103-2425

Mailing address

30 Bergen St
RM 1205
Newark, NJ 07107-3000

National Provider Directory

National Provider Directory

Locations

205 S Orange Ave
Ste C1200
Newark, NJ 07103
Phone (973) 972-2150

90 Bergen St
Ofc Cntr
Newark, NJ 07103
Phone (973) 972-5004

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453420800000",
    "number": "1568829448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST",
            "address_2": "RM 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032425",
            "telephone_number": "973-972-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-22",
        "last_updated": "2016-01-22",
        "status": "A",
        "authorized_official_last_name": "SAULICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR & CEO",
        "authorized_official_telephone_number": "973-972-5004"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.