Provider Demographics
NPI:1942482997
Name:CLIFFORD, MAUREEN ELLEN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELLEN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 KNOLLTOP TER
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1566
Mailing Address - Country:US
Mailing Address - Phone:315-412-4350
Mailing Address - Fax:315-299-5074
Practice Address - Street 1:4552 KNOLLTOP TER
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-1566
Practice Address - Country:US
Practice Address - Phone:315-412-4350
Practice Address - Fax:315-299-5074
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02473792Medicaid