Provider Demographics
NPI:1154653962
Name:CLIFTON BURT PAIN PHYSICIAN, P.C.
Entity Type:Organization
Organization Name:CLIFTON BURT PAIN PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLILFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-928-3363
Mailing Address - Street 1:C2 COTTAGE COURT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:UM
Mailing Address - Phone:973-928-3363
Mailing Address - Fax:973-928-3364
Practice Address - Street 1:C2 COTTAGE CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2142
Practice Address - Country:US
Practice Address - Phone:973-928-3363
Practice Address - Fax:973-928-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251765-2208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty