Provider Demographics
NPI:1346402716
Name:JACKNESS, CLIFTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:JACKNESS
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 1:103 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2805
Mailing Address - Country:US
Mailing Address - Phone:212-772-7628
Mailing Address - Fax:212-772-7062
Practice Address - Street 1:103 E 75TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2805
Practice Address - Country:US
Practice Address - Phone:212-772-7628
Practice Address - Fax:212-772-7062
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250208207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism