Provider Demographics
NPI:1376602839
Name:CRUGNALE, DAVID JAMES (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:CRUGNALE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CANASAWACTA ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1306
Mailing Address - Country:US
Mailing Address - Phone:607-334-6373
Mailing Address - Fax:
Practice Address - Street 1:4211 STATE HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-4305
Practice Address - Country:US
Practice Address - Phone:607-843-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53320Medicare UPIN
NYBB4630Medicare ID - Type Unspecified