Susan M Clark, NP
Individual provider Active NPI Pediatrics Physician · Vineland, NJ
NPI 1609968692 · NPPES record last updated Dec 28, 2011
Key facts
- NPI
- 1609968692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 26NN08675900 (NJ)
- Practice address
- 1318 S Main Road
Vineland, NJ 08360 - Phone
- (856) 691-8585
- Fax
- (856) 691-8489
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NN08675900 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- susan.clark@pedassoc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 26NN08675900 | NJ | Yes |
Addresses
Primary practice location
1318 S Main Road
Vineland, NJ 08360
Mailing address
1318 S Main Road
Vineland, NJ 08360
Phone (856) 691-8585
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7201206 | Medicaid | NJ |
Other providers in Vineland, NJ
- Benjamin John Cisrow IV
- City of Vineland
- City of Vineland Board of Education
- City of Vineland-Health
- Jennifer Anne Clark
- Claybrooks Medical Transportation
- Claybrooks Transportation
- Galen Germaine Claybrooks
- Vaughn Clemens
- Lawrence P Clinton
All providers in Vineland, NJ · Pediatrics Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.