Samantha Fennella Clarke

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

248896 Issued in NY

Practice address

15 Isabella Ave Apt 3R
Bayonne, NJ 07002-4373

Phone

(347) 357-3666

NPI assigned

Jul 13, 2015

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436745600000",
    "number": "1780068494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ISABELLA AVE APT. 3R",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "07002",
            "telephone_number": "347-357-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ISABELLA AVE APT 3R",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070024373",
            "telephone_number": "347-357-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "SAMANTHA",
        "middle_name": "FENNELLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "248896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Rose Ciok, PT, DPT
• City Medical of New Jersey, PC (CityMD Urgent Care)
• City of Bayonne
• City Radiology Center LLC
• Cityrx Pharmacy LLC
• Kimberly Claudio, LPC
• Steven Thomas Coachman, D.C.
• John A Coccaro, MD
• Abigail Kathleen Cohen, M.A., CCC-SLP
• Steven Corey Cohen, DMD

• Licensed Practical Nurse in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Licensed Practical Nurse in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.