MEDICARE: DR. GREGORY A CROOKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	179123	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457351744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A CROOKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30060
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0060
Country	:	US
Telephone Number	:	718-283-7686
Fax Number	:	718-635-7366

Provider Business Practice Location Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:	718-283-7686
Fax Number	:	718-635-7366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/27/2014

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