Provider Demographics
NPI:1558368225
Name:CRESCITELLI, JOHN B (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CRESCITELLI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:10255 NW 60TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2523
Mailing Address - Country:US
Mailing Address - Phone:954-346-1476
Mailing Address - Fax:954-575-0291
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-366-3332
Practice Address - Fax:954-366-4523
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46303OtherBC/BS
46303AMedicare ID - Type Unspecified
FLG88728Medicare UPIN