Provider Demographics
NPI:1619913407
Name:CROWNER, MARTHA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:CROWNER
Suffix:
Gender:F
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-0343
Mailing Address - Country:US
Mailing Address - Phone:212-300-5608
Mailing Address - Fax:212-300-5608
Practice Address - Street 1:412 6TH AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:212-300-5608
Practice Address - Fax:212-300-5608
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1573542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300329Medicaid
NY183BQ1Medicare ID - Type Unspecified
NY02300329Medicaid