Doctor Name: | DR. ALAN B. CLARK |
NPI Number: | 1366500712 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MA20681 |
Business Practice Address: | 240 Central Ave East Orange, NJ - 070183313 |
Business Phone Number: | 9736743500 |
Business Fax Number: | 9736786319 |
Mailing Address: | 240 Central Ave, EAST ORANGE |
State: | NJ |
Postal Code: | 070183313 |
Phone Number: | 9736743500 |
Fax Number: | 9736786319 |
NPI Enumeration Date: | 12/05/2006 |
NPI Last Update Date: | 08/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | MA20681 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |