Provider Demographics
NPI:1417062688
Name:CONTRISTANO, SALVATORE J (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:J
Last Name:CONTRISTANO
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 1:2462 FLATBUSH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5000
Mailing Address - Country:US
Mailing Address - Phone:718-252-4414
Mailing Address - Fax:718-377-1850
Practice Address - Street 1:2462 FLATBUSH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5000
Practice Address - Country:US
Practice Address - Phone:718-252-4414
Practice Address - Fax:718-377-1850
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00170154Medicaid
NY00170154Medicaid
NY961182Medicare ID - Type Unspecified