MEDICARE: ROSSANA CRUCIATA

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	1223G0001X	General Practice Dentistry	DS042584	PA
2	1223G0001X	General Practice Dentistry	22DI02832200	NJ

General Provider Information

NPI Number	:	1619591229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSSANA CRUCIATA

Provider Business Mailing Address
First Line	:	39 HILLTOP TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-1108
Country	:	US
Telephone Number	:	347-609-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 MAPLE AVE
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1733
Country	:	US
Telephone Number	:	732-747-1122
Fax Number	:

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

Provider Enumeration Date	:	05/31/2020
Last Update Date	:	06/29/2026

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Directions to “ ROSSANA CRUCIATA ” Practice Location

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