Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X006586-1 | NY |
NPI | 1962500017 |
---|---|
Provider Name | Eric Edward Croucher |
First Address | Baldwinsville, NY 13027-2720 |
Second Address | Baldwinsville, NY 13027-2720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA1495 | MEDICARE PTAN (01) | |
U18434 | (02) | NY |