1588603203 NPI number — DR. FLAVIO CRISARI M.D.

Table of content: DR. FLAVIO CRISARI M.D. (NPI 1588603203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588603203 NPI number — DR. FLAVIO CRISARI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRISARI
Provider First Name:
FLAVIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588603203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8533 FOREST PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODHAVEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11421-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-441-3970
Provider Business Mailing Address Fax Number:
719-441-6291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8533 FOREST PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11421-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-441-3970
Provider Business Practice Location Address Fax Number:
719-441-6291
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  172573 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09E791 . This is a "BLUE CROOS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0058611 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 110024525 . This is a "PALMETTO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 172573-A17 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01045298 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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