Provider Demographics
NPI:1275535064
Name:CRAWFORD, JEFFREY R (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EAST KING'S HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106
Mailing Address - Country:US
Mailing Address - Phone:856-573-9500
Mailing Address - Fax:856-608-0501
Practice Address - Street 1:37 EAST KING'S HIGHWAY
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106
Practice Address - Country:US
Practice Address - Phone:856-573-9500
Practice Address - Fax:856-608-0501
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05175200207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032123Medicaid
NJ583613Medicare PIN
NJ0032123Medicaid