Healthcare Provider Details

I. General information

NPI: 1710506456
Provider Name (Legal Business Name): JOSEPH ALEXANDER CRESWELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 VESTAL PKWY E FL 2
VESTAL NY
13850-3556
US

IV. Provider business mailing address

4433 VESTAL PKWY E FL 2
VESTAL NY
13850-3556
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax:
Mailing address:
  • Phone: 607-772-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberLPR00214
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP-291
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: