Basic Information
| Provider Information | |||||||||
| NPI: | 1972652378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OWEN & KRAWCHENKO MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1116 ARSENAL ST | ||||||||
| Address2: | SUITE #504 | ||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136012229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157822620 | ||||||||
| FaxNumber: | 3157884980 | ||||||||
| Practice Location | |||||||||
| Address1: | 629 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136014035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157822620 | ||||||||
| FaxNumber: | 3157884980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | CRUMP | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | HIPAA COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3157822620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | YES | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CCSP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.