Provider Demographics
NPI:1285641886
Name:MCCRUDDEN, OWEN JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:JAMES
Last Name:MCCRUDDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-496-0900
Mailing Address - Fax:516-496-0901
Practice Address - Street 1:8029 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-496-0900
Practice Address - Fax:516-496-0901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005928-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU95813Medicare UPIN
NYPJ3021Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER