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NPI Code Detail

MEDICARE: DR. SUSAN JOSIE CRAWFORD-LEMELLE DDS, MPH

MEDICARE: DR. SUSAN JOSIE CRAWFORD-LEMELLE DDS, MPH
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
1122300000XDentist038154NY

General Provider Information

NPI Number : 1932326139
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN JOSIE CRAWFORD-LEMELLE DDS, MPH
Provider Business Mailing Address
First Line : 51 HAMILTON TER
Second Line :
City : NEW YORK
State : NY
Zip : 10031-6402
Country : US
Telephone Number : 212-694-8057
Fax Number :
Provider Business Practice Location Address
First Line : 99 FORT WASHINGTON AVE
Second Line : AMBULATORY CARE NETWORK
City : NEW YORK
State : NY
Zip : 10032-4655
Country : US
Telephone Number : 212-342-0214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 08/21/2019

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