Provider Demographics
NPI:1538142740
Name:CRISAFULLI, JOSEPH A (DPM)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:CRISAFULLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:518-489-3893
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:518-489-3893
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004189213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01161408Medicaid
NY51927BMedicare PIN
NY4675940001Medicare NSC
NY01161408Medicaid