Provider Demographics
NPI:1851313845
Name:PRICE, CRAIG C (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:C
Last Name:PRICE
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 1:42 THROCKMORTON LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2572
Mailing Address - Country:US
Mailing Address - Phone:732-607-1111
Mailing Address - Fax:732-607-0552
Practice Address - Street 1:42 THROCKMORTON LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2572
Practice Address - Country:US
Practice Address - Phone:732-607-1111
Practice Address - Fax:732-607-0552
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA050958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E60462Medicare UPIN
NJ068444BSVMedicare PIN
NJ068444XJTMedicare PIN