Provider Demographics
NPI:1962445320
Name:CRAIG, NICHOLAS PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PETER
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:41 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2160
Mailing Address - Country:US
Mailing Address - Phone:631-928-8300
Mailing Address - Fax:631-928-8337
Practice Address - Street 1:41 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2160
Practice Address - Country:US
Practice Address - Phone:631-928-8300
Practice Address - Fax:631-928-8337
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY166903208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA61687Medicare UPIN