Healthcare Provider Details

I. General information

NPI: 1336198092
Provider Name (Legal Business Name): HEATHER CRAWFORD, D.P.M., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MATHISTOWN RD SUITE 109
LITTLE EGG HARBOR TWP NJ
08087-4061
US

IV. Provider business mailing address

PO BOX 1244
TOMS RIVER NJ
08754-1244
US

V. Phone/Fax

Practice location:
  • Phone: 609-296-3533
  • Fax: 609-296-4742
Mailing address:
  • Phone: 732-349-2795
  • Fax: 732-349-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00248400
License Number StateNJ

VIII. Authorized Official

Name: KAREN B CRAWFORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-349-2795