Organization
PENINSULA EMERGENCY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANE CLARKE MD (PRESIDENT)
(732) 212-0051
Entity
Organization
Contact information
Practice address
29 E 29TH ST, BAYONNE, NJ 07002-4654
(201) 858-5000
Mailing address
66 WEST GILBERT ST, RED BANK, NJ 07701
(732) 212-0051
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH1861
MEDICARE RAILROAD CARRIER
NJ
Enumeration date
03/13/2008
Last updated
10/28/2008
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