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General NPI Number Information
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NPI Number | 1265415947
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Entity Type | Individual
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Provider Name | MR. JOHN CRISPINO
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 4665 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-4152
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Country | US
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Telephone | 718-356-9826
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Fax | 718-966-1594
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Provider Business Mailing Address
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Address Line | 250 BAYVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3636
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Country | US
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Telephone | 718-966-6175
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Fax | 718-966-1594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N003913
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License Number State | NY
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