CLARK DERMATOLOGY LLC
Complete NPI Record 1851562425
Dermatology in Clark, NJ
Active since March 21, 2008CLIA Certified · 8 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Clark Dermatology Llc (NPI 1851562425), a dermatology organization in Clark, NJ. All 39 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1851562425 Field 1/39
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/39
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/39
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: CLARK DERMATOLOGY LLC Field 4/39
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/39
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/39
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 469 MORRIS AVE STE 3 Field 7/39
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ELIZABETH Field 8/39
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: NJ Field 9/39
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 072082904 Field 10/39
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/39
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 7325741399 Field 12/39
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 9085127300 Field 13/39
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1075 CENTRAL AVE Field 14/39
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: CLARK Field 15/39
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NJ Field 16/39
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 070661116 Field 17/39
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/39
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7325741399 Field 19/39
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 7325741433 Field 20/39
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: DOCTOROFF Field 23/39
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: ALEXANDER Field 24/39
- The first name of the authorized official.
- Authorized Official Title or Position: OWNER Field 25/39
- The title or position of the authorized official.
- Authorized Official Telephone Number: 7325741399 Field 26/39
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207ND0101X Field 27/39
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/39
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207ND0900X Field 29/39
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 30/39
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 207N00000X Field 31/39
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: Y Field 32/39
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 33/39
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Name Prefix Text: DR. Field 34/39
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
- Authorized Official Credential Text: D.O. Field 35/39
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 36/39
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 37/39
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 38/39
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Metropolitan Dermatology Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 23
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
400 Franklin Tpke Ste 208
Location 1/23Mahwah, NJ 07430-3539 · Phone (201) 825-0009 · Fax (201) 825-0059
48 S Franklin Tpke Ste 203
Location 2/23Ramsey, NJ 07446-2558 · Phone (201) 825-0009 · Fax (201) 825-0059
1425 Pompton Ave Ste 1-1
Location 3/23Cedar Grove, NJ 07009-1043 · Phone (973) 785-8686 ext. 1800 · Fax (973) 785-8680
3 Lincoln Hwy Ste 305
Location 4/23Edison, NJ 08820-3963 · Phone (732) 549-2448 · Fax (732) 549-6891
3202 John F Kennedy Blvd
Location 5/23Jersey City, NJ 07306-3416 · Phone (201) 792-4500 · Fax (201) 792-5983
703 Kearny Ave
Location 6/23Kearny, NJ 07032-3003 · Phone (201) 998-4699 · Fax (201) 998-9808
622 Boulevard
Location 7/23Kenilworth, NJ 07033-1640 · Phone (908) 241-3181 · Fax (908) 241-1669
55 Newton Sparta Rd Ste 105
Location 8/23Newton, NJ 07860-2772 · Phone (973) 300-0555 · Fax (973) 300-0052
36 Newark Ave Ste 214
Location 9/23Belleville, NJ 07109-4120 · Phone (973) 751-1200 · Fax (973) 450-9395
1805 Route 206
Location 10/23Southampton, NJ 08088-3558 · Phone (609) 388-6098 · Fax (609) 323-1010
505 Omni Dr
Location 11/23Hillsborough, NJ 08844-4528 · Phone (908) 359-6685 · Fax (908) 359-0649
1030 Saint Georges Ave Ste 202
Location 12/23Avenel, NJ 07001-1330 · Phone (732) 750-1331 · Fax (732) 750-3196
469 Morris Ave
Location 13/23Elizabeth, NJ 07208-2904 · Phone (908) 512-7900 · Fax (908) 512-7300
40 Stirling Rd Ste 203
Location 14/23Watchung, NJ 07069-5900 · Phone (908) 753-9600 · Fax (908) 753-3743
1 W Ridgewood Ave Ste 305
Location 15/23Paramus, NJ 07652-2361 · Phone (201) 445-8786 · Fax (201) 445-8811
100 N Black Horse Pike Ste C
Location 16/23Williamstown, NJ 08094-1483 · Phone (856) 362-2200 · Fax (856) 362-2201
1324 Victory Blvd
Location 17/23Staten Island, NY 10301-3917 · Phone (718) 448-4488 · Fax (718) 442-4874
3461 US Highway 22 E Bldg D
Location 18/23Branchburg, NJ 08876-6042 · Phone (908) 725-4777 · Fax (908) 512-7300
175 Cedar Ln Ste A
Location 19/23Teaneck, NJ 07666-4315 · Phone (201) 837-3939 · Fax (201) 837-8336
3071 E Chestnut Ave Ste D12
Location 20/23Vineland, NJ 08361-7847 · Phone (201) 837-3939 · Fax (201) 837-8336
114 Lakeview Ave
Location 21/23South Plainfield, NJ 07080-3422 · Phone (908) 941-2227 · Fax (908) 941-2030
5809 Madison St
Location 22/23West New York, NJ 07093-1005 · Phone (201) 861-4226 · Fax (201) 861-7630
50 Market St
Location 23/23Saddle Brook, NJ 07663-4843 · Phone (201) 368-0011
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