Healthcare Provider Details

I. General information

NPI: 1891880563
Provider Name (Legal Business Name): MASSIMO CRISTOFANILLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/07/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E 68TH ST
NEW YORK NY
10065-6302
US

IV. Provider business mailing address

420 E 70TH ST # LH203
NEW YORK NY
10021-5320
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-5940
  • Fax:
Mailing address:
  • Phone: 164-696-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number336.100606
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number314815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: