Healthcare Provider Details

I. General information

NPI: 1942880067
Provider Name (Legal Business Name): ISAIAH TOBIAS CRUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MYRTLE AVE FL 7
BROOKLYN NY
11201
US

IV. Provider business mailing address

15 METROTECH CTR FLOOR 7, PMB 17578590
BROOKLYN NY
11201-3856
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-8130
  • Fax: 917-967-2115
Mailing address:
  • Phone: 917-284-8130
  • Fax: 917-967-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: