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Organization
PHYSICAL MEDICINE & DIAGNOSTIC TESTING PC
Active
Organization
PHYSICAL MEDICINE & DIAGNOSTIC TESTING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFTON DANIEL BURT MD (OWNER)
(845) 342-0746
Entity
Organization
Contact information
Practice address
54 DOLSON AVE, MIDDLETOWN, NY 10940-6424
(845) 342-1247
(845) 342-1397
Mailing address
PO BOX 473, NEW HAMPTON, NY 10958-0473
(845) 342-0746
(845) 342-1397
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
251765
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588843163
NPI
NY
01
—
2517654W
WORKERS COMPENSATION NUMBER
NY
Enumeration date
10/24/2011
Last updated
10/24/2011
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