MEDICARE: MICHAEL C CRISMALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1573881	NY

General Provider Information

NPI Number	:	1053339838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C CRISMALI MD

Provider Business Mailing Address
First Line	:	PO BOX 639295
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9295
Country	:	US
Telephone Number	:	248-266-4200
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	11835 QUEENS BLVD STE 400
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7211
Country	:	US
Telephone Number	:	646-722-7610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/05/2024

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