Healthcare Provider Details

I. General information

NPI: 1497314652
Provider Name (Legal Business Name): CLIFTON SPRINGS SANITARIUM CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1250
  • Fax:
Mailing address:
  • Phone: 315-462-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PATTON
Title or Position: MANAGER PROVIDER ENROLLMENT
Credential: RN
Phone: 585-922-0527