Healthcare Provider Details

I. General information

NPI: 1821037094
Provider Name (Legal Business Name): CLIFFORD J HURLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LYELL AVE SUITE 101
ROCHESTER NY
14606-5743
US

IV. Provider business mailing address

2211 LYELL AVE SUITE 101
ROCHESTER NY
14606-5743
US

V. Phone/Fax

Practice location:
  • Phone: 585-426-0530
  • Fax: 585-426-9574
Mailing address:
  • Phone: 585-426-0530
  • Fax: 585-426-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number186228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: