Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 012834 | NY |
N | 2251H1200X | Hand | 1041100058 | NY |
NPI | 1346304615 |
---|---|
Provider Name | Mr. Patrick Noel Clough |
First Address | Poughkeepsie, NY 12601-6028 |
Second Address | Poughkeepsie, NY 12601-1260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 15/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02075390 | (05) | NY |
1000720 | ORTHONET - CIGNA (01) | |
1000720 | ORTHONET - US FAMILY HEALTH PLAN (01) | |
9924253 | MVP (01) | |
Q31921 | EMPIRE BCBS (01) |