Provider Demographics
NPI:1144735523
Name:CRANDALL, ROBERT LEWIS
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:CRANDALL
Suffix:
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 1:280 COUNTY ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-2209
Mailing Address - Country:US
Mailing Address - Phone:607-334-6273
Mailing Address - Fax:
Practice Address - Street 1:280 COUNTY ROAD 44
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2209
Practice Address - Country:US
Practice Address - Phone:607-334-6273
Practice Address - Fax:607-334-8770
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045533225100000X
ND2224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist