Provider Demographics
NPI:1861679219
Name:CROUTCH, ROBYN P (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:P
Last Name:CROUTCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IRMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050
Mailing Address - Country:US
Mailing Address - Phone:516-944-4469
Mailing Address - Fax:516-944-9644
Practice Address - Street 1:12 IRMA AVENUE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050
Practice Address - Country:US
Practice Address - Phone:516-944-4469
Practice Address - Fax:516-944-9644
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010011-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5J331Medicare PIN