Healthcare Provider Details

I. General information

NPI: 1891732426
Provider Name (Legal Business Name): CRAIG WILLIAM SCANNEVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PATCHOGUE YAPHANK RD SUITE 3
EAST PATCHOGUE NY
11772-4800
US

IV. Provider business mailing address

43 BAYVIEW AVE
BLUE POINT NY
11715-1710
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-7680
  • Fax: 631-475-7683
Mailing address:
  • Phone: 631-803-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number239635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: