Individual
ELAINE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
235 PORT RICHMOND AVENUE, STATEN ISLAND, NY 10302-1701
(718) 924-2256
(718) 442-0189
Mailing address
235 PORT RICHMOND AVENUE, STATEN ISLAND, NY 10302-1701
(718) 924-2256
(718) 442-0189
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
179996
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01178778
AMERIGROUP
NY
01
—
017999601
NEIGHBORHOOD
NY
01
—
110403000000
FIDELIS CARE
NY
01
—
179996P
HEALTHCARE PARTNERS
NY
01
—
P4364657
UNITEDHEALTH CARE OXFORD
NY
Enumeration date
08/04/2006
Last updated
04/12/2012
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