Lisa M Clark, CPNP-AC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

380567 Issued in NY

Practice address

University Hosp Medical Center Stony BRK
Dept Pediatrics HSC 11TH Floor
Stony Brook, NY 11794-0001

Phone

(631) 444-2967

Fax

(631) 444-6212

NPI assigned

Jun 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lisa.clark@direct.stonybrookmedicine.edu

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1710146220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY HOSP MEDICAL CENTER STONY BROOK",
            "address_2": "DEPT PEDIATRICS HSC 11TH FLOOR",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948111",
            "telephone_number": "631-444-2967",
            "fax_number": "631-444-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY HOSP MEDICAL CENTER STONY BRK",
            "address_2": "DEPT PEDIATRICS HSC 11TH FLOOR",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2967",
            "fax_number": "631-444-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "CPNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "380567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICIENCE NUMBER",
            "identifier": "380567",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Alfred Cinquina Jr.
• Cara Cipriano, LMT
• Danielle Suzanne Citera, PHD
• Daniel Citron, DDS
• Marissa Ciuffo
• Michael James Clores, D.O.
• Doreen Cloughley, D.M.D.
• Joanne Elaine Clyde, NP
• Linda Cocchiarella, MD, MSC
• Maria Cocorikas-Mauceri

• Pediatric Nurse Practitioner in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.