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General NPI Number Information
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NPI Number | 1386990638
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Entity Type | Organization
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Legal Business Name | CROUSE MEDICAL PRACTICE PLLC
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 5823 WIDEWATERS PKWY
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-3081
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Country | US
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Telephone | 315-474-6824
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 91004
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City | ROCHESTER
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State | NY
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Zip | 14692-9104
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Country | US
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Telephone | 315-446-3904
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Fax | 315-552-6590
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Authorized Official
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Title or Position | SOLE SHAREHOLDER
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Name | PAUL KRONENBERG
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Credential | MD
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Telephone | 315-470-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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