Healthcare Provider Details

I. General information

NPI: 1417589656
Provider Name (Legal Business Name): SALVATORE CRISCUOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8031
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 2112
HARTFORD CT
06105-1719
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4888
  • Fax: 860-679-0131
Mailing address:
  • Phone: 203-710-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8735
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8735
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: