Provider Demographics
NPI:1336454198
Name:CROOK, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:CROOK
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 1:1000 MOUNTAIN RD
Mailing Address - Street 2:MT. MCGREGOR CORRECTIONAL FACILITY
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12831
Mailing Address - Country:US
Mailing Address - Phone:518-587-3960
Mailing Address - Fax:
Practice Address - Street 1:1000 MOUNTAIN RD
Practice Address - Street 2:MT. MCGREGOR CORRECTIONAL FACILITY
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12831
Practice Address - Country:US
Practice Address - Phone:518-587-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine