Healthcare Provider Details

I. General information

NPI: 1043498447
Provider Name (Legal Business Name): ROBERT L. CRISTOFARO, MD AND JOHN M NELSON, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WESTCHESTER AVE SUITE 104
PURCHASE NY
10577-2524
US

IV. Provider business mailing address

3010 WESTCHESTER AVE SUITE 104
PURCHASE NY
10577-2524
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-8708
  • Fax: 914-967-5834
Mailing address:
  • Phone: 914-967-8708
  • Fax: 914-967-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number112796
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number150073
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number150073
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number112796
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number112796
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number028526
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number028357
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number150073
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT LOUIS CRISTOFARO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-967-8708