Individual
ELIZABETH C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
317 GEORGE ST, RWJ UNIVERSITY MEDICAL GROUP, NEW BRUNSWICK, NJ 08901-2008
(732) 235-8993
(732) 246-7317
Mailing address
66 W GILBERT ST, 2ND FLOOR, TINTON FALLS, NJ 07701-4947
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
25MA08344100
NJ
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
25MA08344100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0201120
—
NJ
05
—
0295998
—
IA
01
—
35128
WELLMARK BCBS
IA
01
—
P00790533
RR MCR PTAN
NJ
Enumeration date
09/21/2005
Last updated
04/08/2026
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