Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 164704 | NY |
N | 208600000X | Surgeon | 164704 | NY |
N | 2086S0102X | Surgical Critical Care | 164704 | NY |
Y | 2086X0206X | Surgical Oncologist | 164704 | NY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 164704 | CT |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 164704 | NY |
NPI | 1417948761 |
---|---|
Provider Name | Dr. Cliff P Connery |
First Address | Lagrangeville, NY 12540-5108 |
Second Address | Poughkeepsie, NY 12601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01170254 | (05) | NY |
011702T | (05) | NY |
F75214 | (02) |