Healthcare Provider Details

I. General information

NPI: 1588843163
Provider Name (Legal Business Name): CLIFTON DANIEL BURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 MAPLEWOOD AVE
CLIFTON NJ
07013-1157
US

IV. Provider business mailing address

21435 42ND AVE 3RD FLOOR
BAYSIDE NY
11361-2917
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-3363
  • Fax: 973-928-3364
Mailing address:
  • Phone: 718-229-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101242371
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number251765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: