Healthcare Provider Details

I. General information

NPI: 1598148967
Provider Name (Legal Business Name): JOSHUA A CRAIG FNP- BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 07/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PARK ST
MALONE NY
12953-1243
US

IV. Provider business mailing address

133 PARK ST
MALONE NY
12953-1243
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3000
  • Fax:
Mailing address:
  • Phone: 518-483-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339660-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: