Provider Demographics
NPI:1760496350
Name:CROOKS, MICHAEL HUGH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HUGH
Last Name:CROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 ELKWOOD TERRACE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1935
Mailing Address - Country:US
Mailing Address - Phone:201-638-5078
Mailing Address - Fax:
Practice Address - Street 1:2386 JEROME AVE STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6401
Practice Address - Country:US
Practice Address - Phone:917-801-4360
Practice Address - Fax:917-801-4361
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179637207R00000X
NJMA60701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38823Medicare UPIN
NYMC074K9112Medicare ID - Type Unspecified