Healthcare Provider Details

I. General information

NPI: 1205641974
Provider Name (Legal Business Name): LAURA CROTTY NP IN ADULT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST
NYACK NY
10960-2480
US

IV. Provider business mailing address

201 MAIN ST
NYACK NY
10960-2480
US

V. Phone/Fax

Practice location:
  • Phone: 201-212-6933
  • Fax:
Mailing address:
  • Phone: 201-212-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA CROTTY
Title or Position: OWNER
Credential: NP
Phone: 201-212-9633