Provider Demographics
NPI:1891844122
Name:PHILLIPS, CLIFFORD DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DOUGLAS
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LEXINGTON AVENUE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:212-746-6000
Mailing Address - Fax:646-962-0122
Practice Address - Street 1:NEW YORK PRESBYTERIAN-WEILL CORNELL MEDICAL COLLEGE
Practice Address - Street 2:525 E. 68TH STREET - BOX 141
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4885
Practice Address - Country:US
Practice Address - Phone:212-746-6000
Practice Address - Fax:646-962-0122
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2514152085N0700X
VA01010398932085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007200846Medicaid
VA007200846Medicaid
VAE16550Medicare UPIN