Provider Demographics
NPI:1952685836
Name:CRANE, MARGE T
Entity Type:Individual
Prefix:MRS
First Name:MARGE
Middle Name:T
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARGE
Other - Middle Name:T
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:46 MIDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1974
Mailing Address - Country:US
Mailing Address - Phone:631-853-7373
Mailing Address - Fax:
Practice Address - Street 1:200 WIRELESS BLVD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541729-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)