Healthcare Provider Details

I. General information

NPI: 1265017107
Provider Name (Legal Business Name): PHILIP ANDREW CROSLEY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RED MILLS RD
WALLKILL NY
12589-3220
US

IV. Provider business mailing address

800 RED MILLS RD
WALLKILL NY
12589-3220
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-9105
  • Fax:
Mailing address:
  • Phone: 845-744-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01129400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: