Healthcare Provider Details

I. General information

NPI: 1073694287
Provider Name (Legal Business Name): JOSEPH A DICRISTOFARO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEW HOPE RD MEDICAL ARTS BUILDING SUITE #12
PRINCETON WV
24740
US

IV. Provider business mailing address

100 NEW HOPE RD MEDICAL ARTS BUILDING SUITE #12
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-3160
  • Fax: 304-487-3455
Mailing address:
  • Phone: 304-487-3160
  • Fax: 304-487-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH ANTHONY DICRISTOFARO
Title or Position: OWNER
Credential: RT. , CMNT
Phone: 304-487-3160