Provider Demographics
NPI:1407028699
Name:JOSEPH A CRISAFULLI
Entity Type:Organization
Organization Name:JOSEPH A CRISAFULLI
Other - Org Name:LOUDONVILLE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISAFULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-489-3668
Mailing Address - Street 1:120 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1950
Mailing Address - Country:US
Mailing Address - Phone:518-489-3668
Mailing Address - Fax:
Practice Address - Street 1:120 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1950
Practice Address - Country:US
Practice Address - Phone:518-489-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004189213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4675940001Medicare NSC