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NPI Code Detail

MEDICARE: CRAIG FORMAN

MEDICARE:   CRAIG  FORMAN
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
1183500000XPharmacist054997NY

General Provider Information

NPI Number : 1992011027
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG FORMAN
Provider Business Mailing Address
First Line : 58 SHREWSBURY DR
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-3402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 180 W 20TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10011-3649
Country : US
Telephone Number : 212-243-0129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2010
Last Update Date : 07/19/2016

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Directions to “ CRAIG FORMAN ” Practice Location

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