Provider Demographics
NPI:1164421277
Name:CRESPIN, JEFFREY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:CRESPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E END AVE
Mailing Address - Street 2:4HJ
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7953
Mailing Address - Country:US
Mailing Address - Phone:212-288-4115
Mailing Address - Fax:212-288-4115
Practice Address - Street 1:155 E 47TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2009
Practice Address - Country:US
Practice Address - Phone:646-660-4006
Practice Address - Fax:212-671-1350
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213987207R00000X, 207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971622Medicaid
NY01971622Medicaid
NYG01128Medicare UPIN