Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 005928-1 | NY |
NPI | 1285641886 |
---|---|
Provider Name | Dr. Owen James Mccrudden |
First Address | Woodbury, NY 11797 |
Second Address | Woodbury, NY 11797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95813 | (02) | NY |