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General NPI Number Information
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NPI Number | 1881787919
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Entity Type | Individual
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Provider Name | JACQUELINE FAYE CROOPNICK M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 1 BROOKLINE PL STE 423
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City | BROOKLINE
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State | MA
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Zip | 02445-7237
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Country | US
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Telephone | 617-332-9669
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Fax | 617-566-0988
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Provider Business Mailing Address
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Address Line | 1 BROOKLINE PL STE 423
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City | BROOKLINE
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State | MA
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Zip | 02445-7237
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Country | US
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Telephone | 617-332-9669
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Fax | 617-566-0988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 216090
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License Number State | MA
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