Provider Demographics
NPI:1164409538
Name:SEBASTIAN, CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROUTE 24
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2920
Mailing Address - Country:US
Mailing Address - Phone:908-879-1500
Mailing Address - Fax:
Practice Address - Street 1:415 ROUTE 24
Practice Address - Street 2:SUITE E
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2920
Practice Address - Country:US
Practice Address - Phone:908-879-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11951207RC0000X
NJ25MA08227500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60820Medicare UPIN