Provider Demographics
NPI:1740573872
Name:CRUSER, MARY BRIDGID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BRIDGID
Last Name:CRUSER
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 1:1 VIA BORGETTO RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2562
Mailing Address - Country:US
Mailing Address - Phone:845-235-2347
Mailing Address - Fax:
Practice Address - Street 1:1 VIA BORGETTO RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2562
Practice Address - Country:US
Practice Address - Phone:845-235-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273178-12084P0800X
MDD00543732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry