MICHELLE MARILYN CRADDOCK (NPI# 1013182112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013182112 |
| Entity Type | Individual |
| Full Name | MICHELLE MARILYN CRADDOCK |
| Credential | ANP |
| Practice Address |
625 Belle Terre Rd Suite 119 Port Jefferson Medical Assoc Port Jefferson NY 11777 |
| Mailing Address |
625 Belle Terre Rd Suite 119 Port Jefferson Med Assoc Port Jefferson NY 11777 |
| Practice Telephone | 6316420609 |
| Practice Fax Number | 6316420588 |
| Mailing Telephone | 6316420609 |
| Mailing Fax Number | 6316420588 |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | F3325721 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
625 BELLE TERRE RD SUITE 119 PORT JEFFERSON MEDICAL ASSOC |
| City | PORT JEFFERSON |
| State | NY |
| Zip Code | 11777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033102280 | Dinesh Shukla | Psychiatry & Neurology | 625 Belle Terre Rd, Suite 205, Port Jefferson, NY 11777-2316 | 2005-08-23 |
| 1952940942 | Katherine Rosangela Quezada | Nurse Practitioner | 625 Belle Terre Rd, Port Jefferson, NY 11777-2316 | 2019-12-23 |
| 1477093383 | Ryan Fuellbier | Physician Assistant | 625 Belle Terre Rd, 202, Port Jefferson, NY 11777-2316 | 2017-02-27 |
| 1265844716 | John T Mather Memorial Hospital | Physician Assistant | 625 Belle Terre Rd, Suite 203, Port Jefferson, NY 11777-2316 | 2014-06-02 |
| 1811275548 | Ella Rosenbloom | Internal Medicine | 625 Belle Terre Rd, Port Jefferson, NY 11777-2316 | 2011-07-29 |
| 1780983395 | Advanced Laparoscopic Bariatric and General Surgery | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2011-03-22 |
| 1982848156 | Ashish Agarwala | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2009-05-01 |
| 1447414370 | North Suffolk Surgical Assoc | Specialist | 625 Belle Terre Rd, Suite 201, Port Jefferson, NY 11777-2316 | 2008-07-10 |
| 1306929716 | S Chandra Shekher | Psychiatry & Neurology | 625 Belle Terre Rd, Suite 211, Port Jefferson, NY 11777 | 2006-10-23 |
| 1659313690 | Arif Ahmad | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2006-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568088615 | Aqsa Ashraf | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mather Hospital Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-24 |
| 1366068975 | Manal Ahmad | Student in an Organized Health Care Education/Training Program | 75 N County Rd, Level 2 Cmo Suite, Internal Medicine Re, Mather Hospital, Port Jefferson, NY 11777 | 2020-06-19 |
| 1639794555 | Umair Ahmad Ansari | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mother Hospital, Internal Medicine Re, Level 2 - Cmd Suite, Port Jefferson, NY 11777 | 2020-06-16 |
| 1578188132 | Manasi Sule | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Mather Hospital, Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-10 |
| 1508480716 | Imona Subedi | Student in an Organized Health Care Education/Training Program | 75 N Country Road, Level 2 - Cmo Suite, Mather Hospital Internal Medicine Residency Program, Port Jefferson, NY 11777 | 2020-06-03 |
| 1184252108 | Romana Imtiaz Syed | Student in an Organized Health Care Education/Training Program | Liza M Dominioni,mather Hospital,internal Medicine, Residency Program,level 2-cmo Suite,75 N Country Rd, Port Jefferson, NY 11777 | 2020-03-27 |
| 1649807348 | Mustafa Mohammed Abdulsada | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Ny, Level 2 - Cmo Suite, Port Jefferson, NY 11777 | 2020-03-24 |
| 1184264764 | Girma Moges Gamme | Surgery | 625 Belle Terre Rd, Suite 203 Mather Hospital, Port Jefferson, NY 11777 | 2020-01-10 |
| 1811554637 | Kausar Ali | Nurse Practitioner | 408 Thompson Street, Port Jefferson, NY 11777 | 2019-05-28 |
| 1073097531 | Ministry for Hope, Inc. Montfort Therapeutic Residence | Residential Treatment Facility, Physical Disabilities | 100 Stonyhill Road, Port Jefferson, NY 11777 | 2018-09-20 |
| Find all providers in zip 11777 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982108353 | Three Village Medicine PC | Family Medicine | 24 Jefferson Landing Cir, Port Jefferson, NY 11777-1978 | 2018-03-21 |
| 1043287006 | Erika M Jurasits | Family Medicine | 170 N Country Rd Ste 2, Port Jefferson, NY 11777-2606 | 2006-03-08 |
| 1396749669 | Lewis Lee Bateman | Family Medicine | 125 Oakland Ave Suite 205, Mather Primary Care, Port Jefferson, NY 11777 | 2005-06-02 |
| 1295162543 | Mather Primary Care, Pllc | Family Medicine | 125 Oakland Ave, Suite 205, Port Jefferson, NY 11777-2130 | 2013-10-02 |
| 1174820955 | Family Medical Wellness PC | Family Medicine | 125 Oakland Ave, Ste 203, Port Jefferson, NY 11777 | 2011-02-14 |
| 1144548918 | Jessica Lynn Blydenburgh | Family Medicine | 125 Oakland Ave, Port Jefferson, NY 11777-2130 | 2010-05-04 |
| 1114197910 | Francis M. Francin | Family Medicine | 680 Main St, Suite2, Port Jefferson, NY 11777-2203 | 2008-03-07 |
| 1568504322 | Steven G. Selter | Family Medicine | 102 Prospect St, Port Jefferson, NY 11777-1813 | 2007-02-12 |
| 1508943317 | James Thomas Kelly | Family Medicine | 70 N Country Rd, Suite 105, Port Jefferson, NY 11777-2161 | 2006-11-01 |
| 1144306341 | Rhonda S Burmeister | Family Medicine | 70 N Country Rd, Suite 105, Port Jefferson, NY 11777-2161 | 2006-10-31 |
| Find all providers in PORT JEFFERSON | ||||
| City | PORT JEFFERSON |
| Zip Code | 11777 |
Please comment or provide details below to improve the information on MICHELLE MARILYN CRADDOCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.