Provider Demographics
NPI:1295712404
Name:CAMPBELL, CRAIG JOHN (DPM PC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOHN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2410
Mailing Address - Country:US
Mailing Address - Phone:718-981-5098
Mailing Address - Fax:718-981-6792
Practice Address - Street 1:827 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2410
Practice Address - Country:US
Practice Address - Phone:718-981-5098
Practice Address - Fax:718-981-6792
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004711-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01232493Medicaid
NY01232493Medicaid
U17875Medicare UPIN