Provider Demographics
NPI:1942247622
Name:HOWELL, CLIFTON O (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:O
Last Name:HOWELL
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 1:550 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-795-9155
Mailing Address - Fax:201-795-9157
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-795-9155
Practice Address - Fax:201-795-9157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1925202Medicaid
NJ1925202Medicaid
NJ455199Medicare ID - Type Unspecified