Elsa Jimenez Clark, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

186750 Issued in NY

Practice address

1259 Wantagh Ave
Wantagh, NY 11793-2205

Phone

(516) 221-7971

Fax

(516) 221-8117

NPI assigned

Jun 28, 2005

Sex

Female

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)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elsa J Clark MD

  • Internal Medicine Physician
  • Wantagh, NY
  • NPI 1952673261
  Authorized official Same address or phone

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1770589343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 WANTAGH AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932205",
            "telephone_number": "516-221-7971",
            "fax_number": "516-221-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 WANTAGH AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932205",
            "telephone_number": "516-221-7971",
            "fax_number": "516-221-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELSA",
        "middle_name": "JIMENEZ",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "186750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald Vincent Ciccarello, D.P.M.
• Michelle Cinnamo
• Howard Cintron, PH.D.
• Veronica M. Citarrella, LMSW
• Lucille Citera Mazzer, P.T.
• John M Clark, LMSW
• Nicole Janine Clark, MS STUDENTS WITH DIS
• Robert Henry Clark, M.D.
• Clear Image Inc.
• Joanna Cathryn Clerici

• Internal Medicine Physician in Wantagh, NY
• Providers in Wantagh, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.