Provider Demographics
NPI:1053302711
Name:CRASTA, JOVITA M (MD)
Entity Type:Individual
Prefix:
First Name:JOVITA
Middle Name:M
Last Name:CRASTA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HEALTHY WAY
Mailing Address - Street 2:ATT PHYSICIAN BILLING -CREDENTIALS
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-255-1616
Mailing Address - Fax:516-255-4672
Practice Address - Street 1:2277 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3148
Practice Address - Country:US
Practice Address - Phone:516-377-5400
Practice Address - Fax:516-377-5490
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYNY1671562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245496Medicaid
NY00245496Medicaid
NY05E221Medicare PIN