Provider Demographics
NPI:1124007562
Name:CRACCO, JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:CRACCO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 118
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-2042
Mailing Address - Fax:718-270-3748
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 118
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-2042
Practice Address - Fax:718-270-3748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1185022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16905Medicare UPIN