Healthcare Provider Details

I. General information

NPI: 1659469641
Provider Name (Legal Business Name): ROBERT LOUIS CRISTOFARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WESTCHESTER AVE SUITE 104
PURCHASE NY
10577-2535
US

IV. Provider business mailing address

3010 WESTCHESTER AVENUE 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 TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number112796
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number028526
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number112796
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number028526
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: