NPIMap

Organization Active NPI

Clifton Geriatric Center

  • Speech-Language Pathologist
  • Somerset, MA
National Provider Identifier
1104144765
Registry record updated May 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
4762 Issued in MA
Legal business name
CLIFTON GERIATRIC CENTER
Practice address
500 Wilbur Ave
Somerset, MA 02725-2051
Phone
(508) 675-7589
Fax
(508) 675-0132
NPI assigned
May 6, 2010
Organization subpart
Yes
Parent organization
CLIFTON GERIATRIC CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Timothy S Pederson, MS, PT
Title
Director of Rehabilitation
Phone
(508) 675-7589

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 4762 MA Primary

Addresses

Primary practice location

500 Wilbur Ave
Somerset, MA 02725-2051

Mailing address

500 Wilbur Ave
Somerset, MA 02725-2051
Phone (508) 675-7589

Other names 1

  • Clifton Outpatient Rehabilitation Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clifton Geriatrics5 organizations share this tax ID, including this one
Part of
Clifton Geriatrics

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Wilbur Ave
Somerset, MA 02725
Phone (508) 675-7589

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275004800000",
    "number": "1104144765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WILBUR AVE",
            "city": "SOMERSET",
            "state": "MA",
            "postal_code": "027252051",
            "telephone_number": "508-675-7589",
            "fax_number": "508-675-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WILBUR AVE",
            "city": "SOMERSET",
            "state": "MA",
            "postal_code": "027252051",
            "telephone_number": "508-675-7589",
            "fax_number": "508-675-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFTON GERIATRIC CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLIFTON GERIATRIC CENTER",
        "enumeration_date": "2010-05-06",
        "last_updated": "2010-05-28",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR OF REHABILITATION",
        "authorized_official_telephone_number": "508-675-7589",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, PT"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "4762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clifton Outpatient Rehabilitation Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerset, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.