Provider Demographics
NPI:1588603203
Name:CRISARI, FLAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FLAVIO
Middle Name:
Last Name:CRISARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8533 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1130
Mailing Address - Country:US
Mailing Address - Phone:718-441-3970
Mailing Address - Fax:719-441-6291
Practice Address - Street 1:8533 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1130
Practice Address - Country:US
Practice Address - Phone:718-441-3970
Practice Address - Fax:719-441-6291
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09E791OtherBLUE CROOS BLUE SHIELD
NY0058611OtherGHI
NY110024525OtherPALMETTO
NY172573-A17OtherHEALTH FIRST
NY01045298Medicaid
NY09E791OtherBLUE CROOS BLUE SHIELD
NY110024525OtherPALMETTO