Individual
DR. CRAIG B ORDWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 MAIN ST, NORTHPORT, NY 11768-1722
(631) 754-2663
Mailing address
PO BOX 359, NORTHPORT, NY 11768-0359
(631) 754-2663
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
129877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00-68330
—
NY
01
—
11-2572132
TAX I D
NY
Enumeration date
03/02/2007
Last updated
12/06/2010
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