Provider Demographics
NPI:1174981484
Name:CLIFTON PHYSICIAN ASSISTANT LLC
Entity type:Organization
Organization Name:CLIFTON PHYSICIAN ASSISTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-779-7979
Mailing Address - Street 1:1033 ROUTE 46
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2473
Mailing Address - Country:US
Mailing Address - Phone:973-779-7979
Mailing Address - Fax:973-779-7970
Practice Address - Street 1:1033 ROUTE 46
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2473
Practice Address - Country:US
Practice Address - Phone:973-779-7979
Practice Address - Fax:973-779-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00383100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty