MEDICARE: DR. JOHN B. CRESCITELLI D.O.

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	OS7485	FL

General Provider Information

NPI Number	:	1558368225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B. CRESCITELLI D.O.

Provider Business Mailing Address
First Line	:	10255 NW 60TH PL
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-2523
Country	:	US
Telephone Number	:	954-346-1476
Fax Number	:	954-575-0291

Provider Business Practice Location Address
First Line	:	1 W SAMPLE RD
Second Line	:	SUITE 302
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3547
Country	:	US
Telephone Number	:	954-366-3332
Fax Number	:	954-366-4523

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/30/2016

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