Healthcare Provider Details

I. General information

NPI: 1770760035
Provider Name (Legal Business Name): CRAIG L MURCRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W MAIN ST
ST JOHNSVILLE NY
13452-1225
US

IV. Provider business mailing address

PO BOX 87
ST JOHNSVILLE NY
13452-0087
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-2886
  • Fax:
Mailing address:
  • Phone: 518-568-2886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MURCRAY
Title or Position: OWNER
Credential: O.D.
Phone: 518-568-2886