Provider Demographics
NPI:1114964699
Name:PUNZALAN, CRISPINO (MD)
Entity Type:Individual
Prefix:
First Name:CRISPINO
Middle Name:
Last Name:PUNZALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35088
Mailing Address - Street 2:MONTCLAIR ANESTHESIA
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07193-5088
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40516207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1757202Medicaid
NJ012568DFHMedicare ID - Type Unspecified
NJD06050Medicare UPIN