Healthcare Provider Details

I. General information

NPI: 1912980897
Provider Name (Legal Business Name): EFRAIN CRESPO-GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 ALLERTON AVE
BRONX NY
10467
US

IV. Provider business mailing address

645 ALLERTON AVE
BRONX NY
10467-7403
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-7771
  • Fax: 215-291-2587
Mailing address:
  • Phone: 718-547-7771
  • Fax: 215-291-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD049380L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: