=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043498447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT L. CRISTOFARO, MD AND JOHN M NELSON, MD,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 09/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 WESTCHESTER AVE SUITE 104
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-967-8708
-----------------------------------------------------
Fax | 914-967-5834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 WESTCHESTER AVE SUITE 104
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-967-8708
-----------------------------------------------------
Fax | 914-967-5834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT LOUIS CRISTOFARO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 914-967-8708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 112796
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 150073
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 150073
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 112796
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 112796
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 028526
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 028357
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 150073
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------