Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. CLIFTON RUDOLPH LAKE, MD
Active Sole ProprietorPsychiatric Hospital · VALLEY STREAM, NY
Registration Details
- NPI Number
- 1063698330
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 16, 2008 (18.279947037115 yrs)
- Last Updated
- May 20, 2020
- Licenses
-
ACN1119 (FL)P60621 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
46 BROOK RDVALLEY STREAM, NY, 115812416Browse NY providers · Browse ZIP 11581
- Phone
- 5165080128
- Primary Specialty
-
Psychiatric Hospital
283Q00000X
- Additional Specialty
- Psychiatric Hospital
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.