Provider Demographics
NPI:1477687325
Name:CRANDALL, JOHN E (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PENBROOKE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2033
Mailing Address - Country:US
Mailing Address - Phone:585-377-5990
Mailing Address - Fax:585-219-5715
Practice Address - Street 1:421 PENBROOKE DR
Practice Address - Street 2:SIUTE 4
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2033
Practice Address - Country:US
Practice Address - Phone:585-377-5990
Practice Address - Fax:585-219-5715
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000011276237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist