Provider Demographics
NPI:1730264052
Name:CLIFFORD, EILEEN M (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22-18 BROADWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:201-797-4503
Mailing Address - Fax:201-797-4270
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1552
Practice Address - Country:US
Practice Address - Phone:201-797-4503
Practice Address - Fax:201-797-4270
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03511000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2843102Medicaid
NJ157209Medicare UPIN
NJ2843102Medicaid