Healthcare Provider Details

I. General information

NPI: 1801067822
Provider Name (Legal Business Name): CRAIG J CAMPBELL DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 FOREST AVE
STATEN ISLAND NY
10310
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 TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004711-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4417760001
License Number StateNY

VIII. Authorized Official

Name: DR. CRAIG JOHN CAMPBELL
Title or Position: OWNER
Credential: DPM
Phone: 718-981-5098