Basic Information
| Provider Information | |||||||||
| NPI: | 1093701179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITY OF CLIFTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 WASHINGTON ST | ||||||||
| Address2: | C/O DCM, INC. | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087536855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322403030 | ||||||||
| FaxNumber: | 7329140470 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 CLIFTON AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070132708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322403030 | ||||||||
| FaxNumber: | 7329140470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 02/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | D'AMORE | ||||||||
| AuthorizedOfficialFirstName: | DARYL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 9734075801 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | N/A | NJ | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 4615301 | 05 | NJ | MEDICAID |