MEDICARE: CRAFTFORM INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710105325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAFTFORM INC.

Provider Business Mailing Address
First Line	:	23 KENYAN PLACE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10552
Country	:	US
Telephone Number	:	914-664-2571
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 KENYAN PLACE
Second Line	:	CRAFTFORM INC
City	:	MT VERNON
State	:	NY
Zip	:	10552-3018
Country	:	US
Telephone Number	:	914-664-2571
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ESTHER ELSTEIN
Credential	:
Telephone Number	:	914-664-2571

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	10/08/2010

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Directions to “CRAFTFORM INC. ” Practice Location

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