Provider Demographics
NPI:1265834741
Name:CRESPO, CARLO A
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:A
Last Name:CRESPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 S MAIN ST # 344
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3353
Mailing Address - Country:US
Mailing Address - Phone:646-450-8455
Mailing Address - Fax:646-570-1986
Practice Address - Street 1:169 S MAIN ST # 344
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3353
Practice Address - Country:US
Practice Address - Phone:646-450-8455
Practice Address - Fax:646-570-1986
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program