Provider Demographics
NPI:1346347861
Name:CRISTELLO, THOMAS G (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:CRISTELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BROADWAY STE 904
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8120
Mailing Address - Country:US
Mailing Address - Phone:212-375-9802
Mailing Address - Fax:212-375-9931
Practice Address - Street 1:928 BROADWAY STE 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8120
Practice Address - Country:US
Practice Address - Phone:212-375-9802
Practice Address - Fax:212-375-9931
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4N751Medicare PIN