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General NPI Number Information
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NPI Number | 1134666423
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Entity Type | Organization
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Legal Business Name | JOHN B CRESCITELLI D.O. P.A.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 1 W SAMPLE RD SUITE 302
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3547
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Country | US
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Telephone | 954-366-3332
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Fax | 954-366-4523
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Provider Business Mailing Address
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Address Line | 5944 CORAL RIDGE DR #167
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3300
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Country | US
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Telephone | 954-383-1867
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Fax | 954-575-0291
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JOHN B CRESCITELLI
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Credential | DO
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Telephone | 954-383-1867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7485
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License Number State | FL
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