Healthcare Provider Details

I. General information

NPI: 1063486934
Provider Name (Legal Business Name): CLIFFORD A MEVS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 NEW DORP LANE 2ND FLOOR
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

148 NEW DORP LANE 2ND FLOOR
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-5437
  • Fax: 718-979-2653
Mailing address:
  • Phone: 718-980-5437
  • Fax: 718-979-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number160103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: