Provider Demographics
NPI:1144367848
Name:SNYDER, CRAIG JORDAN (DC PT)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JORDAN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DC PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1545 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3503
Mailing Address - Country:US
Mailing Address - Phone:718-477-9797
Mailing Address - Fax:718-720-5444
Practice Address - Street 1:55-77 SCHANCK RD STE B-17
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-414-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008716-1111N00000X
NY0345901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX0F261Medicare PIN