MEDICARE: NICHOLAS JOSEPH CRISCI PA-C

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	363A00000X	Physician Assistant	028090	NY
2	363A00000X	Physician Assistant	7577	AZ

General Provider Information

NPI Number	:	1487120077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOSEPH CRISCI PA-C

Provider Business Mailing Address
First Line	:	622 W 168TH ST # VC-260
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-8720
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W 168TH ST STE 260
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-304-6172
Fax Number	:

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

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	03/28/2026

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Directions to “ NICHOLAS JOSEPH CRISCI PA-C” Practice Location

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