Provider Demographics
NPI:1588843163
Name:BURT, CLIFTON DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:DANIEL
Last Name:BURT
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 1:21435 42ND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2917
Mailing Address - Country:US
Mailing Address - Phone:718-229-4868
Mailing Address - Fax:
Practice Address - Street 1:176 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1157
Practice Address - Country:US
Practice Address - Phone:973-928-3363
Practice Address - Fax:973-928-3364
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012423712081P2900X
NY2517652081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine