Provider Demographics
NPI:1548331622
Name:CRUICKSHANK, ROYSTON (MD)
Entity type:Individual
Prefix:MR
First Name:ROYSTON
Middle Name:
Last Name:CRUICKSHANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DUNDAR ROAD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3024
Mailing Address - Country:US
Mailing Address - Phone:973-788-5180
Mailing Address - Fax:973-788-5183
Practice Address - Street 1:11 DUNDAR ROAD
Practice Address - Street 2:SUITE #105
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3024
Practice Address - Country:US
Practice Address - Phone:973-788-5180
Practice Address - Fax:973-788-5183
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QM0850X
NJ25MAD68715002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG83172Medicare UPIN