Provider Demographics
NPI:1245233634
Name:CRISCITIELLO, ARNOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:CRISCITIELLO
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 1:85 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4561
Mailing Address - Country:US
Mailing Address - Phone:201-445-2830
Mailing Address - Fax:201-445-7471
Practice Address - Street 1:85 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-445-2830
Practice Address - Fax:201-445-7471
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05971000207X00000X, 207XS0117X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200040496OtherRR MDCR#
NJ80P901OtherBC/BS OF NY ID #
NJ2448223OtherAETNA HMO ID #
NJP2164406OtherOXFORD ID #
NJ5973528OtherAETNA PPO ID #
NJ200040496OtherRR MDCR#
NJ042470WX5Medicare PIN