Healthcare Provider Details

I. General information

NPI: 1295712404
Provider Name (Legal Business Name): CRAIG JOHN CAMPBELL DPM PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 FOREST AVE
STATEN ISLAND NY
10310-2410
US

IV. Provider business mailing address

827 FOREST AVE
STATEN ISLAND NY
10310-2410
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-5098
  • Fax: 718-981-6792
Mailing address:
  • Phone: 718-981-5098
  • Fax: 718-981-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004711-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: