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General NPI Number Information
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NPI Number | 1487120077
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH CRISCI PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 622 W 168TH ST STE 260
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-304-6172
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 E RIO SALADO PKWY
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City | TEMPE
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State | AZ
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Zip | 85281-7489
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Country | US
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Telephone | 480-388-9133
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7577
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 028090
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License Number State | NY
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