Healthcare Provider Details

I. General information

NPI: 1912551243
Provider Name (Legal Business Name): CLIFTON PAIN & VEIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 CLIFTON AVE
CLIFTON NJ
07013-3638
US

IV. Provider business mailing address

1060 CLIFTON AVE
CLIFTON NJ
07013-3638
US

V. Phone/Fax

Practice location:
  • Phone: 732-631-8090
  • Fax:
Mailing address:
  • Phone: 732-631-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMMAR BAZERBASHI
Title or Position: OWNER
Credential: M.D.
Phone: 732-631-8090