Provider Demographics
NPI:1801080411
Name:WREDE, CRAIG HARRY (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:HARRY
Last Name:WREDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MADISON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-867-0405
Mailing Address - Fax:212-867-0409
Practice Address - Street 1:315 MADISON AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-867-0405
Practice Address - Fax:212-867-0409
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO8895-1111NR0400X
CADC 28445111NR0400X
NJ38MC00522800111NR0400X
NYX008895-1111N00000X
NJDC28445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWR023152Medicare PIN
CADC 28445Medicare PIN