Individual
JEANANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
525 E 68TH ST, BOX 141, NEW YORK, NY 10021-4870
(212) 746-2059
(212) 746-8596
Mailing address
525 E 68TH ST, BOX 141, NEW YORK, NY 10065-4885
(212) 746-2059
(212) 746-8596
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
008259
NY
Other
Enumeration date
10/03/2006
Last updated
09/18/2023
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