DR. CLYDE A. PEMBERTON (NPI# 1629225594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629225594 |
| Entity Type | Individual |
| Full Name | DR. CLYDE A. PEMBERTON |
| Credential | M.D. |
| Practice Address |
15 S 9th St Newark NJ 07107-2147 |
| Practice Telephone | 9734979360 |
| Practice Fax Number | 9734979100 |
| Mailing Telephone | 9734979360 |
| Mailing Fax Number | 9734979100 |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2008-08-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
47443 | NJ | Allopathic & Osteopathic Physicians |
| Street Address |
15 S 9TH ST |
| City | NEWARK |
| State | NJ |
| Zip Code | 07107-2147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356505150 | Living New Inc | Substance Abuse Rehabilitation Facility | 15 S 9th St, Newark, NJ 07107-2147 | 2008-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134747272 | Kobie Blair Morgan | Counselor | Kobie Blair Morgan, Esq., Mba, Ma, Lpc, 76-78 First Street, Suite 3, Newark, NJ 07107 | 2020-07-06 |
| 1811522634 | Yasheika Hermitt South | Licensed Practical Nurse | North 11th Street, Newark, NJ 07107 | 2020-03-12 |
| 1568941375 | Orange Street Spec LLC | Dentist | 509a Orange Street Suite A, Newark, NJ 07107 | 2018-08-13 |
| 1548617103 | Jose Andres Morales | Case Manager/Care Coordinator | 541 Roseville Av., Newark, NJ 07107 | 2016-05-24 |
| 1053743997 | Center for Wound Science and Healing | General Acute Care Hospital | 495 North 13th Street, 2nd Floor, Newark, NJ 07107 | 2013-08-02 |
| 1750620944 | Jeevan M Mathew | Physical Therapist | 500 0range Street, Suite 2, Newark, NJ 07107 | 2013-02-07 |
| 1982967386 | D & M Quality of Life Services, LLP | In Home Supportive Care | 285 Roseville Avenue, Suite 118, Newark, NJ 07107 | 2012-06-20 |
| 1710121496 | Paul Hsu | Pharmacist | 421 Bloomfield Ave, Guardys, Newark, NJ 07107 | 2009-04-27 |
| 1194969774 | Prescriptions Etc Inc. | Clinic/Center | 421 Bloomfield Ave., Guardys, Newark, NJ 07107 | 2009-04-27 |
| 1821269630 | Chandra Gupta | Pediatrics | 156 Roseville Avenue, Newark, NJ 07107 | 2008-03-19 |
| Find all providers in zip 07107 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447244967 | Angel A Hernandez | Psychiatry & Neurology | 1160 Raymond Blvd, Newark, NJ 07102-4199 | 2005-09-12 |
| 1164489621 | Seacrest Medical Associates, P.a. | Psychiatry & Neurology | 1160 Raymond Blvd, Newark, NJ 07102-4168 | 2006-04-27 |
| 1720072242 | Rolando Y Hong | Psychiatry & Neurology | 1160 Raymond Blvd, Newark, NJ 07102-4199 | 2005-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720637150 | Caremed Plus P.C. | Psychiatry & Neurology | 508 Hamburg Tpke Ste 107, Wayne, NJ 07470-8482 | 2019-09-09 |
| 1003375023 | Center for Network Therapy | Psychiatry & Neurology | 20 Gibson Pl Ste 103, Freehold, NJ 07728-4837 | 2019-03-19 |
| 1548751258 | Garden State Treatment Center LLC | Psychiatry & Neurology | 350 Sparta Ave Ste A-201, Sparta, NJ 07871 | 2018-05-29 |
| 1295255149 | Bergen Psychiatric Care LLC | Psychiatry & Neurology | 65 N Maple Ave Ste 104, Ridgewood, NJ 07450-3233 | 2017-06-21 |
| 1255654752 | Tamer William Wassef | Psychiatry & Neurology | 424 Baldwin Ave, Jersey City, NJ 07306 | 2010-03-11 |
| 1861651077 | Jeffrey H Simon | Psychiatry & Neurology | 1930 Marlton Pike E Ste U100, Cherry Hill, NJ 08003-4212 | 2008-06-03 |
| 1730353814 | Joseph Glen Vitolo | Psychiatry & Neurology | 27 Hillsborough Dr, Monroe, NJ 08831-4746 | 2008-04-18 |
| 1992927859 | Todd Meredith Wilding | Psychiatry & Neurology | 7 Macculloch Ave., 2nd Floor, Morristown, NJ 07960 | 2007-05-02 |
| 1174648232 | Jacob H Jacoby | Psychiatry & Neurology | 654 Ave C, Suite 201, Bayonne, NJ 07002 | 2007-03-20 |
| 1265506158 | Cecilia Kalijman Karol | Psychiatry & Neurology | 1055 River Rd, Apt.511 S., Edgewater, NJ 07020-1364 | 2006-11-20 |
| Find all providers with the same taxonomy | ||||
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| 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.