Provider Demographics
NPI:1487760963
Name:COLIN CLARKE M.D. P.C.
Entity type:Organization
Organization Name:COLIN CLARKE M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-456-8077
Mailing Address - Street 1:PO BOX 350185
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-0185
Mailing Address - Country:US
Mailing Address - Phone:718-743-6225
Mailing Address - Fax:866-317-2671
Practice Address - Street 1:2518 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3916
Practice Address - Country:US
Practice Address - Phone:718-934-5395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208242-8207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02317435Medicaid
NY02317435Medicaid
NYWAC941Medicare ID - Type UnspecifiedMEDICARE GROUP ID