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General NPI Number Information
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NPI Number | 1124103973
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Entity Type | Organization
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Legal Business Name | CLIFTON WALLINGTON MEDICAL GROPU
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1033 CLIFTON AVE SUITE 210
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City | CLIFTON
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State | NJ
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Zip | 07013-3517
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Country | US
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Telephone | 973-473-4624
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Fax | 973-476-4547
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Provider Business Mailing Address
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Address Line | 1033 CLIFTON AVE SUITE 210
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City | CLIFTON
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State | NJ
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Zip | 07013-3517
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Country | US
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Telephone | 973-473-4624
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Fax | 973-476-4547
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Authorized Official
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Title or Position | BILLING MANANGER
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Name | MS. AMY DEVIRGILIO
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Credential |
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Telephone | 973-473-4624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA05999500
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License Number State | NJ
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