Healthcare Provider Details

I. General information

NPI: 1265415947
Provider Name (Legal Business Name): MR. JOHN CRISPINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN CRISPINO DPM

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 AMBOY RD
STATEN ISLAND NY
10312-4152
US

IV. Provider business mailing address

250 BAYVIEW AVE
STATEN ISLAND NY
10309-3636
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-9826
  • Fax: 718-966-1594
Mailing address:
  • Phone: 718-966-6175
  • Fax: 718-966-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: