Healthcare Provider Details

I. General information

NPI: 1982774188
Provider Name (Legal Business Name): NORA V ESTEBAN-CRUCIANI MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD PALEY 1
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK RD PALEY 1
PHILADELPHIA PA
19141-3018
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7170
  • Fax: 215-456-3436
Mailing address:
  • Phone: 215-456-7170
  • Fax: 215-456-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number193867
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD459470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: