Provider Demographics
NPI:1972652378
Name:OWEN & KRAWCHENKO MD PC
Entity Type:Organization
Organization Name:OWEN & KRAWCHENKO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP
Authorized Official - Phone:315-782-2620
Mailing Address - Street 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE #504
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-782-2620
Mailing Address - Fax:315-788-4980
Practice Address - Street 1:629 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4035
Practice Address - Country:US
Practice Address - Phone:315-782-2620
Practice Address - Fax:315-788-4980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50947AMedicare ID - Type Unspecified