Provider Demographics
NPI:1831277391
Name:CLIFTON MEDICAL PC
Entity type:Organization
Organization Name:CLIFTON MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-371-4610
Mailing Address - Street 1:615 ROUTE 146A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1606
Mailing Address - Country:US
Mailing Address - Phone:518-371-4610
Mailing Address - Fax:518-371-8307
Practice Address - Street 1:615 ROUTE 146A
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1606
Practice Address - Country:US
Practice Address - Phone:518-371-4610
Practice Address - Fax:518-371-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51869AMedicare PIN