Healthcare Provider Details

I. General information

NPI: 1831283910
Provider Name (Legal Business Name): SHAWN M CRABTREE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 HAMBURG TPKE SUITE 102
WAYNE NJ
07470-2162
US

IV. Provider business mailing address

342 HAMBURG TPKE SUITE 102
WAYNE NJ
07470-2162
US

V. Phone/Fax

Practice location:
  • Phone: 973-904-1177
  • Fax: 973-904-1166
Mailing address:
  • Phone: 973-904-1177
  • Fax: 973-904-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMA056562
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: