Robert Henry Clark, M.D.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

144682 Issued in NY

Practice address

1259 Wantagh Ave
Wantagh, NY 11793-2205

Phone

(516) 221-7971

Fax

(516) 221-8117

NPI assigned

Jun 30, 2005

Last updated

Jun 24, 2008By the provider in NPPES

Sex

Male

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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.

• Robert H Clark MD PLLC

  • Specialist
  • Wantagh, NY
  • NPI 1700825692
  Authorized official Same address or phone

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1932106408",
    "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": "ROBERT",
        "middle_name": "HENRY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NY",
            "license": "144682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01565177",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Veronica M. Citarrella, LMSW
• Lucille Citera Mazzer, P.T.
• Elsa Jimenez Clark, M.D.
• John M Clark, LMSW
• Nicole Janine Clark, MS STUDENTS WITH DIS
• Clear Image Inc.
• Joanna Cathryn Clerici
• Justine Clifford, D.P.T
• Shari Nancy Cohen, OD
• Samantha Collins, LMHC

• Infectious Disease Physician in Wantagh, NY
• Providers in Wantagh, NY by specialty
• Infectious Disease 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.