MR. TIMOTHY JERUM CLARK (NPI# 1518492008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518492008 |
| Entity Type | Individual |
| Full Name | MR. TIMOTHY JERUM CLARK |
| Credential | NP |
| Practice Address |
246 Hart Ave Staten Island NY 10310-3022 |
| Practice Telephone | 3473068981 |
| Mailing Telephone | 3473068981 |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2017-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
341667 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083096341 | Timothy Clark | Student in an Organized Health Care Education/Training Program | 521 S 7th St, Apt 502, Minneapolis, MN 55415-1620 | 2015-06-23 |
| 1154665446 | Timothy Ross Clark | Physical Therapy Assistant | 201 10th Ave N, Twin Falls, ID 83301-6372 | 2012-11-27 |
| 1013233477 | Timothy Albert Clark | Massage Therapist | 2010 Bonnycastle Ave Apt 1f, Louisville, KY 40205-1118 | 2010-04-10 |
| 1265501829 | Timothy K Clark | Counselor | 6341 Kyllenon Hill Rd, Clinton, WA 98236-8633 | 2006-11-07 |
| 1194800946 | Timothy Paul Clark | Dentist | 12392 Pleasant Ave., Becker, MN 55308-0098 | 2006-10-26 |
| 1609966415 | Timothy Lew Clark | Social Worker | 880 Lee Street, Suite 208, Des Plaines, IL 60016 | 2006-10-13 |
| 1538263801 | Timothy Clark | Social Worker | 1170 Main St Rt 6a, West Barnstable, MA 02665 | 2006-09-08 |
| 1043265663 | Timothy M Clark | Internal Medicine | 4820 Riverbend Rd Ste 100, Boulder, CO 80301-2618 | 2006-05-23 |
| 1629027974 | Timothy Clark | Physician Assistant | 4201 Buffalo Road, North Chili, NY 14514 | 2006-05-06 |
| 1407814726 | Timothy A Clark | Internal Medicine | 2250 Millennium Way, Ste 400, Enola, PA 17025 | 2006-05-03 |
| Street Address |
246 HART AVE |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10310-3022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710506027 | Sini Bijoy | Student in an Organized Health Care Education/Training Program | 355 Bard Ave Dept of Medicine Villa Bldg 1st Floor, Staten Island, NY 10310 | 2020-04-16 |
| 1497374243 | Isabelle Mulango | Student in an Organized Health Care Education/Training Program | 355 Bard Ave Dep't of Medicine Villa Bldg 1st Floor, Staten Island, NY 10310 | 2020-04-12 |
| 1174152839 | Yvonne Hanna | Student in an Organized Health Care Education/Training Program | 355 Bard Ave Depatment of Medicine, Villa Bldg 1st Floor, Staten Island, NY 10310 | 2020-04-05 |
| 1588293591 | Muhammad Shaheryar Haider | Student in an Organized Health Care Education/Training Program | 355 Bard Ave Dept of Medicine, Villa Bldg 1st Floor, Staten Island, NY 10310 | 2020-04-02 |
| 1427602846 | Mc Queen and Otuyelu Lcsw Wellness | Social Worker | 941 Forest Avenue, Staten Island, NY 10310 | 2019-07-25 |
| 1780240333 | Zeinab Mohammed Kaleemullah | Student in an Organized Health Care Education/Training Program | 355 Bard Avenue Department of Psychiatry, Staten Island, NY 10310 | 2019-05-18 |
| 1164086229 | Francine Fane Foo | Student in an Organized Health Care Education/Training Program | 355 Bard Ave., Depart of Medicine Villa Bldg 1st Floor, Staten Island, NY 10310 | 2019-04-24 |
| 1528621893 | Francis Njukeng Atemnkeng | Student in an Organized Health Care Education/Training Program | 355 Bard Ave Dept of Medicine Villa Bldg, 1st Floor, Staten Island, NY 10310 | 2019-04-22 |
| 1467015966 | Anum Humayun | Student in an Organized Health Care Education/Training Program | 355 Bard Ave. Dept of Medicine Villa Bldg 1st Floor, Staten Island, NY 10310 | 2019-04-19 |
| 1760951842 | Syed M Faizaan Zabiullah | Student in an Organized Health Care Education/Training Program | 355 Bard Avenue, Department of Medicine, Villa Building, 1st Floor,staten Island, New York, NY 10310 | 2018-11-18 |
| Find all providers in zip 10310 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871194027 | Wai Ying Chan | Nurse Practitioner | 659 Britton Ave, Staten Island, NY 10304-4463 | 2020-11-04 |
| 1215542923 | Margaret Chifong Tam | Nurse Practitioner | 85 Venice Avenue, Staten Island, NY 10304 | 2020-09-10 |
| 1215540638 | Shanna Hinckson | Nurse Practitioner | 53 Tillman St, Staten Island, NY 10314-5680 | 2020-08-25 |
| 1104438548 | Amanda Power | Nurse Practitioner | 64 Lovell Ave, Staten Island, NY 10314-4969 | 2020-08-18 |
| 1497367817 | Darya Olekhnovich | Nurse Practitioner | 25 Navesink Pl, Staten Island, NY 10306-5622 | 2020-08-18 |
| 1194335372 | Kimberly Sage | Nurse Practitioner | 36 Carly Ct, Staten Island, NY 10309-2735 | 2020-08-03 |
| 1932718855 | Christine Louise Lutrario | Nurse Practitioner | 293 Edinboro Rd, Staten Island, NY 10306-1204 | 2020-07-27 |
| 1447877592 | Mirena Khaimova | Nurse Practitioner | 302 Getz Ave, Staten Island, NY 10312-2433 | 2020-07-05 |
| 1063039220 | Hima Girish | Nurse Practitioner | 64 Galloway Ave, Staten Island, NY 10302-2528 | 2020-07-02 |
| 1245854314 | Desiree Joy Ambrosio | Nurse Practitioner | 45 Burnside Ave, Staten Island, NY 10302-2302 | 2020-06-03 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10310 |
Please comment or provide details below to improve the information on MR. TIMOTHY JERUM CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.