Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 60 271708 | NY |
N | 225100000X | Physical Therapist | 023719-1 | NY |
NPI | 1255582458 |
---|---|
Provider Name | Brian Cruickshank |
First Address | East Setauket, NY 11733-3472 |
Second Address | East Setauket, NY 11733-3472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 14/08/2013 |