Provider Demographics
NPI:1821037094
Name:HURLEY, CLIFFORD J (DO)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:J
Last Name:HURLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LYELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5743
Mailing Address - Country:US
Mailing Address - Phone:585-426-0530
Mailing Address - Fax:585-426-9574
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-426-0530
Practice Address - Fax:585-426-9574
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94334Medicare UPIN
RA4153Medicare ID - Type Unspecified