MEDICARE: DR. ARNOLD CRISCITIELLO M.D.

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	207X00000X	Orthopaedic Surgery Physician	25MA05971000	NJ
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	25MA05971000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200040496	OTHER	NJ	RR MDCR#
2	80P901	OTHER	NJ	BC/BS OF NY ID #
3	2448223	OTHER	NJ	AETNA HMO ID #
4	P2164406	OTHER	NJ	OXFORD ID #
5	5973528	OTHER	NJ	AETNA PPO ID #

General Provider Information

NPI Number	:	1245233634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD CRISCITIELLO M.D.

Provider Business Mailing Address
First Line	:	85 S MAPLE AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-4561
Country	:	US
Telephone Number	:	201-445-2830
Fax Number	:	201-445-7471

Provider Business Practice Location Address
First Line	:	85 S MAPLE AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450
Country	:	US
Telephone Number	:	201-445-2830
Fax Number	:	201-445-7471

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/26/2019

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