Provider Demographics
NPI:1558567149
Name:PASSEN, CLIFFORD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:BRUCE
Last Name:PASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:268 BROADWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2367
Mailing Address - Country:US
Mailing Address - Phone:518-583-3002
Mailing Address - Fax:518-584-1666
Practice Address - Street 1:268 BROADWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2367
Practice Address - Country:US
Practice Address - Phone:518-583-3002
Practice Address - Fax:518-584-1666
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1995592084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry