MEDICARE: CLIFTON PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA07199200	NJ

General Provider Information

NPI Number	:	1437115581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFTON PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	469 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07011-3227
Country	:	US
Telephone Number	:	973-253-0266
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07011-3227
Country	:	US
Telephone Number	:	973-253-0266
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BOLIVAR PASCUAL
Credential	:	M.D.
Telephone Number	:	973-253-0266

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/17/2007

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