Individual
DR. CLIFTON RUDOLPH LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
46 BROOK RD, VALLEY STREAM, NY 11581-2416
(516) 508-0128
Mailing address
46 BROOK RD, VALLEY STREAM, NY 11581-2416
(516) 508-0128
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
ACN1119
FL
283Q00000X
Psychiatric Hospital
Primary
P60621
NY
Other
Enumeration date
01/16/2008
Last updated
05/20/2020
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