Clyde A. Pemberton, M.D.

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

47443 Issued in NJ

Practice address

15 S 9TH St
Newark, NJ 07107-2147

Phone

(973) 497-9360

Fax

(973) 497-9100

NPI assigned

Aug 22, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219363200000",
    "number": "1629225594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S 9TH ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071072147",
            "telephone_number": "973-497-9360",
            "fax_number": "973-497-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S 9TH ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071072147",
            "telephone_number": "973-497-9360",
            "fax_number": "973-497-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "CLYDE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-22",
        "last_updated": "2008-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NJ",
            "license": "47443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Idalissie Altagracia Peguero, APN, PMHNPBC
• Stephanie Peguero, RN
• Mingzhuo Pei
• Daniel Peikes, DMD
• Pemberton M.D P.C
• Colin A, Pemberton, M.D.
• Velma Opal Pemberton, APN
• Edwin Antonio Pena, MD
• Evelyn Pena, RD
• Rafael A Pena Jr., LCADC

• Addiction Medicine (Psychiatry & Neurology) Physician in Newark, NJ
• Providers in Newark, NJ by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; 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.