Individual
DR. PRAEOPHAYOM CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2000
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA11029400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2017
Last updated
05/26/2022
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