SHANNON LAW-CLARK PA-C
NPI 1861177370
Physician Assistant - Surgical in Montclair, NJ

Q: What is Shannon Law-clark's NPI number?

The NPI number for Shannon Law-clark is 1861177370. It was assigned to this individual provider in the NPPES registry on June 21, 2023.

Q: What is Shannon Law-clark's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Law-clark was last updated on September 13, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 21, 2023PECOS EnrolledAccepts Medicare Assignment

1 SEYMOUR ST, MONTCLAIR, NJ 07042(973) 302-6025(862) 357-8424 Get Directions Write a Review

NPPES record last updated: September 13, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Shannon Law-clark Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON LAW-CLARK PA-C (NPI 1861177370) is an individual surgical provider in Montclair, New Jersey, licensed in New Jersey (25MP00788200) and active in the NPI registry since June 2023. She is enrolled in Medicare PECOS, is affiliated with Holy Name Medical Center, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1861177370

Entity TypeIndividualFemale

Primary Taxonomy363AS0400X

Provider Legal NameSHANNON LAW-CLARKCredential: PA-C

Location Address1 SEYMOUR STMontclair, NJ 07042-3771

Mailing Address54a Hercules RdKenvil, NJ 07847-2674 · (973) 699-7861

Phone(973) 302-6025

Fax(862) 357-8424

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateJune 21, 2023

Last NPPES UpdateSeptember 13, 2023

NPPES CertifiedSeptember 13, 2023

✔ NPI 1861177370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in NJ · 25MP00788200

Also ListedPhysician AssistantTaxonomy 363A00000X · License 25MP00788200 (NJ)

1 SEYMOUR ST, Montclair, NJ 07042

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shannon Law-clark Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2466806369

PECOS Enrollment IDI20230926003883

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Holy Name Medical Center

Acute Care Hospitals · Teaneck, NJ

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310008

Location718 Teaneck RdTeaneck, NJ 07666 · Bergen County

Emergency services Birthing friendly

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JELENA VASIC MD

Internal Medicine