Healthcare Provider Details

I. General information

NPI: 1720684095
Provider Name (Legal Business Name): CRAIG J CAMPBELL DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/09/2020
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CRAIG J CAMPBELL
Title or Position: OWNER
Credential: DPM
Phone: 718-981-5098