Provider Demographics
NPI:1710105325
Name:CRAFTFORM INC.
Entity Type:Organization
Organization Name:CRAFTFORM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-664-2571
Mailing Address - Street 1:23 KENYAN PLACE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552
Mailing Address - Country:US
Mailing Address - Phone:914-664-2571
Mailing Address - Fax:
Practice Address - Street 1:23 KENYAN PLACE
Practice Address - Street 2:CRAFTFORM INC
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3018
Practice Address - Country:US
Practice Address - Phone:914-664-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527179Medicaid
NY00527179Medicaid