Provider Demographics
NPI:1770548174
Name:CROSBY, ELAINE (M D)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8084
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-8084
Mailing Address - Country:US
Mailing Address - Phone:845-481-4055
Mailing Address - Fax:845-514-2266
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-481-4055
Practice Address - Fax:845-514-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196507-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1723904Medicaid
NYG18796Medicare UPIN
NY3319P1Medicare ID - Type Unspecified