Provider Demographics
NPI:1932326139
Name:CRAWFORD-LEMELLE, SUSAN JOSIE (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOSIE
Last Name:CRAWFORD-LEMELLE
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HAMILTON TER
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6402
Mailing Address - Country:US
Mailing Address - Phone:212-694-8057
Mailing Address - Fax:
Practice Address - Street 1:99 FORT WASHINGTON AVE
Practice Address - Street 2:AMBULATORY CARE NETWORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4655
Practice Address - Country:US
Practice Address - Phone:212-342-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist