Provider Demographics
NPI:1235184649
Name:CLIFTON-FINE HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:CLIFTON-FINE HEALTHCARE CORPORATION
Other - Org Name:CLIFTON FINE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIERDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-848-4260
Mailing Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:STAR LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13690-3143
Mailing Address - Country:US
Mailing Address - Phone:315-848-3351
Mailing Address - Fax:315-848-2314
Practice Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Practice Address - Street 2:
Practice Address - City:STAR LAKE
Practice Address - State:NY
Practice Address - Zip Code:13690-3143
Practice Address - Country:US
Practice Address - Phone:315-848-3351
Practice Address - Fax:315-848-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163749207P00000X
NY160381207P00000X
NY206562207P00000X
NY099273207Q00000X
NY247006207Q00000X
NY4458700C282NC0060X
NY331877363LF0000X
NY004138364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354201Medicaid
NY330179OtherBLUE CROSS
NY02332016Medicaid
NY330179OtherBLUE CROSS
NYBA0829Medicare PIN
NYBA0111Medicare PIN
NY33Z307Medicare ID - Type Unspecified