Provider Demographics
NPI:1417996513
Name:CRUICKSHANK, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:CRUICKSHANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2608
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2608
Mailing Address - Country:US
Mailing Address - Phone:631-287-8600
Mailing Address - Fax:631-204-1585
Practice Address - Street 1:117 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4923
Practice Address - Country:US
Practice Address - Phone:631-287-8600
Practice Address - Fax:631-204-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1090901208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00434895Medicaid
NY00434895Medicaid
B20484Medicare UPIN