Basic Information
| Provider Information | |||||||||
| NPI: | 1538500152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROUSE MEDICAL PRACTICE PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEUROSURGERY OFFICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 IRVING AVE | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154753999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 475 IRVING AVE | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154753999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2013 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | KRONENBERG | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 3154707825 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CROUSE MEDICAL PRACTICE PLLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.