Healthcare Provider Details

I. General information

NPI: 1932045614
Provider Name (Legal Business Name): MR. DUGUAY S CRUMBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DELAWARE AVE APT 2
ALBANY NY
12202-1332
US

IV. Provider business mailing address

PO BOX 10223
ALBANY NY
12201-5223
US

V. Phone/Fax

Practice location:
  • Phone: 518-364-8320
  • Fax:
Mailing address:
  • Phone: 332-284-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number$$$$$$$$$
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: