Provider Demographics
NPI:1154841617
Name:COLEMAN, CRAIG (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501A W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8308
Mailing Address - Country:US
Mailing Address - Phone:631-818-6000
Mailing Address - Fax:631-396-4260
Practice Address - Street 1:501A W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8308
Practice Address - Country:US
Practice Address - Phone:631-818-6000
Practice Address - Fax:631-396-4260
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303853207Q00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program