Provider Demographics
NPI:1285197954
Name:CROWLEY, KATELYN M (MD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:M
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HUDSON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2993
Mailing Address - Country:US
Mailing Address - Phone:716-322-9896
Mailing Address - Fax:
Practice Address - Street 1:99 HUDSON ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2993
Practice Address - Country:US
Practice Address - Phone:734-276-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72697207R00000X
390200000X
NY319261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY319261OtherLICENSE
NYXC2174768OtherX WAIVER
CT72697OtherLICENSE
CT72697OtherLICENSE