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General NPI Number Information
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NPI Number | 1295877116
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Entity Type | Organization
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Legal Business Name | OWEN MCCRUDDEN DPM, PC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 8029 JERICHO TPKE
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City | WOODBURY
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State | NY
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Zip | 11797
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Country | US
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Telephone | 516-496-0900
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Fax | 516-496-0901
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Provider Business Mailing Address
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Address Line | 8029 JERICHO TPKE
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City | WOODBURY
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State | NY
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Zip | 11797
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Country | US
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Telephone | 516-496-0900
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Fax | 516-496-0901
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. OWEN JAMES MCCRUDDEN
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Credential | DPM
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Telephone | 516-496-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5928-1
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License Number State | NY
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