1336198092 NPI number — HEATHER CRAWFORD, D.P.M., L.L.C.

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 1336198092 NPI number — HEATHER CRAWFORD, D.P.M., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEATHER CRAWFORD, D.P.M., L.L.C.
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:
1336198092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-349-2795
Provider Business Mailing Address Fax Number:
732-349-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MATHISTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
LITTLE EGG HARBOR TWP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08087-4061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-296-3533
Provider Business Practice Location Address Fax Number:
609-296-4742
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
732-349-2795

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  25MD00248400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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