Provider Demographics
NPI:1104959774
Name:DUKOFSKY, CLIFFORD A (DC)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:A
Last Name:DUKOFSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 NESCONSET HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1000
Mailing Address - Country:US
Mailing Address - Phone:631-698-9800
Mailing Address - Fax:631-698-9801
Practice Address - Street 1:2233 NESCONSET HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1000
Practice Address - Country:US
Practice Address - Phone:631-698-9800
Practice Address - Fax:631-698-9801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09133-2OtherWORKERS' COMP.
NYA400014775OtherMEDICARE PTAN
NY02220033Medicaid
NYC09133-2OtherWORKERS' COMP.