Provider Demographics
NPI:1942235577
Name:JAMES R CLIFFORD MD PC
Entity Type:Organization
Organization Name:JAMES R CLIFFORD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-996-0055
Mailing Address - Street 1:255 WEST SPRING VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607
Mailing Address - Country:US
Mailing Address - Phone:201-996-0055
Mailing Address - Fax:201-996-0584
Practice Address - Street 1:255 WEST SPRING VALLEY AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607
Practice Address - Country:US
Practice Address - Phone:201-996-0055
Practice Address - Fax:201-996-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3436306Medicaid
NJ6494803OtherCIGNA
360991OtherWELL CHOICE
NJ4327746OtherAETNA
NJ3436309Medicaid
P3506926OtherOXFORD
NJ31304OtherUHC
360991OtherWELL CHOICE
CL452629Medicare ID - Type Unspecified
NJ452629Medicare PIN