Provider Demographics
NPI:1962502005
Name:CROWLEY, BROOKE V (DPM)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:V
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N OCEAN AVE
Mailing Address - Street 2:P.O. BOX 1254
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2303
Mailing Address - Country:US
Mailing Address - Phone:163-187-8115
Mailing Address - Fax:163-187-8024
Practice Address - Street 1:15 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2303
Practice Address - Country:US
Practice Address - Phone:163-187-8115
Practice Address - Fax:163-187-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0045451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440555Medicaid
NYP50671Medicare ID - Type Unspecified
NY01440555Medicaid