Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 006461 | NY |
N | 222Z00000X | Podiatrist | 006461 | NY |
Y | 213ES0131X | Foot Surgery | 006461 | NY |
NPI | 1174829923 |
---|---|
Provider Name | Dr. Roxann Vinelle Clarke |
First Address | New York, NY 10038-3122 |
Second Address | New York, NY 10038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 13/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303480059 | (05) | NY |
A400072759 | (02) | NY |