Provider Demographics
NPI:1538297825
Name:CLIFTON GERIATRIC CENTER
Entity Type:Organization
Organization Name:CLIFTON GERIATRIC CENTER
Other - Org Name:CLIFTON OUTPATIENT REHABILITATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:508-675-7589
Mailing Address - Street 1:500 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02725-2051
Mailing Address - Country:US
Mailing Address - Phone:508-675-7589
Mailing Address - Fax:508-672-7422
Practice Address - Street 1:500 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-2051
Practice Address - Country:US
Practice Address - Phone:508-675-7589
Practice Address - Fax:508-672-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty