=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770635872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL CROSSER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 ALVAHS LN
-----------------------------------------------------
City | CUTCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11935-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-924-4411
-----------------------------------------------------
Fax | 631-924-0563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 ALVAHS LN
-----------------------------------------------------
City | CUTCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11935-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 146662
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------