Healthcare Provider Details

I. General information

NPI: 1215393574
Provider Name (Legal Business Name): ELAINE CRIVELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2016
Last Update Date: 01/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 ROUTE 173
BLOOMSBURY NJ
08804-3112
US

IV. Provider business mailing address

960 ROUTE 173
BLOOMSBURY NJ
08804-3112
US

V. Phone/Fax

Practice location:
  • Phone: 908-313-0872
  • Fax:
Mailing address:
  • Phone: 908-313-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00498700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: