Basic Information
| Provider Information | |||||||||
| NPI: | 1225128408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWLEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 E 70TH ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100219800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127460373 | ||||||||
| FaxNumber: | 2127467481 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 E 70TH ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100219800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127462250 | ||||||||
| FaxNumber: | 2127468808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 219731 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 219731 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 219731 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 02662100 | 05 | NY | MEDICAID |