Healthcare Provider Details

I. General information

NPI: 1447244587
Provider Name (Legal Business Name): CROUSE RADIOLOGY ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

PO BOX 2004
EAST SYRACUSE NY
13057-4504
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7551
  • Fax: 315-470-2719
Mailing address:
  • Phone: 315-362-5285
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN DRUMM
Title or Position: CEO
Credential:
Phone: 315-234-7608