Provider Demographics
NPI:1528056652
Name:CROWLEY, ALICE L (ANP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:L
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:155 W MERRICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3743
Mailing Address - Country:US
Mailing Address - Phone:516-379-3139
Mailing Address - Fax:516-379-5790
Practice Address - Street 1:155 W MERRICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3743
Practice Address - Country:US
Practice Address - Phone:516-379-3139
Practice Address - Fax:516-379-5790
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3019041363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS55260Medicare UPIN
NY95V6703621Medicare PIN