Provider Demographics
NPI:1194860619
Name:O'DELL, CROSSLEY
Entity Type:Individual
Prefix:DR
First Name:CROSSLEY
Middle Name:
Last Name:O'DELL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CROSSLEY
Other - Middle Name:
Other - Last Name:O'DELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:86 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2816
Mailing Address - Country:US
Mailing Address - Phone:914-241-4312
Mailing Address - Fax:914-241-7524
Practice Address - Street 1:86 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2816
Practice Address - Country:US
Practice Address - Phone:914-241-4312
Practice Address - Fax:914-241-7524
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20738Medicare UPIN
NY98D941Medicare PIN