Provider Demographics
NPI:1134666423
Name:JOHN B CRESCITELLI D.O. P.A.
Entity Type:Organization
Organization Name:JOHN B CRESCITELLI D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRESCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-383-1867
Mailing Address - Street 1:5944 CORAL RIDGE DR
Mailing Address - Street 2:#167
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3300
Mailing Address - Country:US
Mailing Address - Phone:954-383-1867
Mailing Address - Fax:954-575-0291
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-366-3332
Practice Address - Fax:954-366-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7485261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care