Healthcare Provider Details

I. General information

NPI: 1497663538
Provider Name (Legal Business Name): MR. THOMAS RAYMOND CROTTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 BROADWAY
NEW YORK NY
10012-2606
US

IV. Provider business mailing address

3135 BROADWAY APT 12
NEW YORK NY
10027-4653
US

V. Phone/Fax

Practice location:
  • Phone: 646-516-9818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: