Provider Demographics
NPI:1760561468
Name:CROSLEY MEDICAL PRODUCTS INC
Entity Type:Organization
Organization Name:CROSLEY MEDICAL PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:631-595-2547
Mailing Address - Street 1:19 KATHLEEN DR EAST
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5808
Mailing Address - Country:US
Mailing Address - Phone:631-595-2547
Mailing Address - Fax:631-595-1732
Practice Address - Street 1:60 S 2ND ST
Practice Address - Street 2:STE E
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4717
Practice Address - Country:US
Practice Address - Phone:631-595-2547
Practice Address - Fax:631-595-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00935259Medicaid
NY0457960001Medicare NSC