Provider Demographics
NPI:1063541472
Name:ORDWAY, CRAIG B (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:ORDWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-0359
Mailing Address - Country:US
Mailing Address - Phone:631-754-2663
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1722
Practice Address - Country:US
Practice Address - Phone:631-754-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00-68330Medicaid
NY11-2572132OtherTAX I D
NY11-2572132OtherTAX I D
NY00-68330Medicaid