1245278241 NPI number — MICHAEL MCCRAIN MSPT CSCS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245278241 NPI number — MICHAEL MCCRAIN MSPT CSCS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL MCCRAIN MSPT CSCS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245278241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 MONTAUK HWY
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
MORICHES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11955-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-878-7012
Provider Business Mailing Address Fax Number:
631-878-7015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MONTAUK HWY
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
MORICHES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11955-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-878-7012
Provider Business Practice Location Address Fax Number:
631-878-7015
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCRAIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
631-878-7012

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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