Provider Demographics
NPI:1336388529
Name:CLIFFORD J HURLEY D.O., LLC
Entity type:Organization
Organization Name:CLIFFORD J HURLEY D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-426-0530
Mailing Address - Street 1:2211 LYELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5743
Mailing Address - Country:US
Mailing Address - Phone:585-426-0530
Mailing Address - Fax:525-426-9574
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-426-0530
Practice Address - Fax:525-426-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186228207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y16634Medicare UPIN
BA0294Medicare PIN