Provider Demographics
NPI:1336434588
Name:CRATTY, RICHARD LYNN III
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LYNN
Last Name:CRATTY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W 26TH ST
Mailing Address - Street 2:APT 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6714
Mailing Address - Country:US
Mailing Address - Phone:203-464-0459
Mailing Address - Fax:
Practice Address - Street 1:251 W 26TH ST
Practice Address - Street 2:APT 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6714
Practice Address - Country:US
Practice Address - Phone:203-464-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568681-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse