| Clark Medical Service Llc | |
|
135 Bloomfield Ave Ste F Bloomfield NJ 07003-5902 | |
| (862) 213-0033 | |
| Not Available |
| Full Name | Clark Medical Service Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 135 Bloomfield Ave Ste F, Bloomfield, New Jersey |
| Authorized Official Name and Position | Mounir Y Abdelshahid (M.D.) |
| Authorized Official Contact | 8622130033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Medical Service Llc 135 Bloomfield Ave Ste F Bloomfield NJ 07003-5902 Ph: () - | Clark Medical Service Llc 135 Bloomfield Ave Ste F Bloomfield NJ 07003-5902 Ph: (862) 213-0033 |
| NPI Number | 1710431291 |
|---|---|
| Provider Enumeration Date | 08/12/2016 |
| Last Update Date | 08/12/2016 |
| Medicare PECOS PAC ID | 0648559658 |
|---|---|
| Medicare Enrollment ID | O20161115002255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710431291 | NPI | - | NPPES |
| 0343757 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Catalino L Dela Cruz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124131016 PECOS PAC ID: 7012981657 Enrollment ID: I20050315000102 |
| Provider Name | Mounir Y Abdelshahid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780872838 PECOS PAC ID: 6204011257 Enrollment ID: I20110506000288 |
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