MEDICARE: MR. JEFFREY S CRISPIN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00451900	NJ

General Provider Information

NPI Number	:	1225044209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY S CRISPIN PT

Provider Business Mailing Address
First Line	:	1023 N MAIN ST
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071
Country	:	US
Telephone Number	:	856-256-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 N BROADWAY
Second Line	:	SUITE 1 HEARTLAND REHABILITATION SERVICES OF NJ INC
City	:	PITMAN
State	:	NJ
Zip	:	08071
Country	:	US
Telephone Number	:	856-256-9800
Fax Number	:	856-218-0358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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