Marlene S Clifford
Individual provider Active NPI Contractor · Hampton Bays, NY
NPI 1154566388 · NPPES record last updated Dec 2, 2008
Key facts
- NPI
- 1154566388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 361780911 (NY)
- Practice address
- 255 W Montauk Hwy
Hampton Bays, NY 11946-3512 - Phone
- (631) 728-3698
- NPI assigned
- Dec 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 361780911 | NY | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 361780911 | NY | Yes |
Addresses
Primary practice location
255 W Montauk Hwy
Hampton Bays, NY 11946-3512
Mailing address
255 W Montauk Hwy
PO Box 626
Hampton Bays, NY 11946-3512
Phone (631) 728-3698
Other providers in Hampton Bays, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.