Healthcare Provider Details

I. General information

NPI: 1932402005
Provider Name (Legal Business Name): MICHAELCRINCOLI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST SUITE 106
NATICK MA
01760-7700
US

IV. Provider business mailing address

67 UNION ST SUITE 106
NATICK MA
01760-7700
US

V. Phone/Fax

Practice location:
  • Phone: 508-650-9999
  • Fax: 508-653-1054
Mailing address:
  • Phone: 508-650-9999
  • Fax: 508-653-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CRINCOLI
Title or Position: PREISDENT
Credential: MD
Phone: 508-650-9999