Provider Demographics
NPI:1346304615
Name:CLOUGH, PATRICK NOEL (PT CHT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:NOEL
Last Name:CLOUGH
Suffix:
Gender:M
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6028
Mailing Address - Country:US
Mailing Address - Phone:845-632-6775
Mailing Address - Fax:845-632-6777
Practice Address - Street 1:1809 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1260
Practice Address - Country:US
Practice Address - Phone:845-632-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10411000582251H1200X
NY012834225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02075390Medicaid
1000720OtherORTHONET - US FAMILY HEALTH PLAN
1000720OtherORTHONET - CIGNA
9924253OtherMVP
Q31921OtherEMPIRE BCBS
Q31921OtherEMPIRE BCBS
NY02075390Medicaid
29333OtherGHI HMO
2C3846OtherPHS
ANC1566OtherOXFORD
NY11Q31921Medicare PIN
43648OtherMVP
6602574OtherGHI
Q31921OtherEMPIRE BCBS