Healthcare Provider Details

I. General information

NPI: 1407028699
Provider Name (Legal Business Name): JOSEPH A CRISAFULLI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RUSSELL RD
ALBANY NY
12205-1950
US

IV. Provider business mailing address

120 RUSSELL RD
ALBANY NY
12205-1950
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-3668
  • Fax:
Mailing address:
  • Phone: 518-489-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004189
License Number StateNY

VIII. Authorized Official

Name: JOSEPH CRISAFULLI
Title or Position: OWNER
Credential:
Phone: 518-489-3668