CLC Medical Services Inc.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MP00056300 Issued in NJ

Legal business name

CLC MEDICAL SERVICES INC.

Practice address

150 Bay St
Suite 915
Jersey City, NJ 07302-2900

Phone

(973) 986-4013

NPI assigned

Jun 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles ChandlerNPI 1417996901

Title

Physician Assistant

Phone

(973) 986-4013

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Charles Chandler, PA-C

  • Medical Physician Assistant
  • Jersey City, NJ
  • NPI 1417996901
  NPD (past) Authorized official

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598791063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BAY ST",
            "address_2": "SUITE 915",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073022900",
            "telephone_number": "973-986-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BAY ST",
            "address_2": "SUITE 915",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073022900",
            "telephone_number": "973-986-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLC MEDICAL SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "973-986-4013",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "MP00056300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER INDIVUA",
            "identifier": "1417996",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.