Provider Demographics
NPI:1073694287
Name:JOSEPH A DICRISTOFARO
Entity Type:Organization
Organization Name:JOSEPH A DICRISTOFARO
Other - Org Name:NUMED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DICRISTOFARO
Authorized Official - Suffix:
Authorized Official - Credentials:RT , CMNT
Authorized Official - Phone:304-487-3160
Mailing Address - Street 1:100 NEW HOPE RD
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE #12
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740
Mailing Address - Country:US
Mailing Address - Phone:304-487-3160
Mailing Address - Fax:304-487-3455
Practice Address - Street 1:100 NEW HOPE RD
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE #12
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-487-3160
Practice Address - Fax:304-487-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0080053000Medicaid
WV0080053000Medicaid