1346304615 NPI number — MR. PATRICK NOEL CLOUGH PT CHT

Table of content: MR. PATRICK NOEL CLOUGH PT CHT (NPI 1346304615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346304615 NPI number — MR. PATRICK NOEL CLOUGH PT CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLOUGH
Provider First Name:
PATRICK
Provider Middle Name:
NOEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT CHT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346304615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 SOUTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-6028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-632-6775
Provider Business Mailing Address Fax Number:
845-632-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 SOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-632-6775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251H1200X , with the licence number:  1041100058 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 012834 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02075390 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000720 . This is a "ORTHONET - US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000720 . This is a "ORTHONET - CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9924253 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q31921 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".




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