Provider Demographics
NPI:1588820815
Name:VISCO, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:VISCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3735
Mailing Address - Country:US
Mailing Address - Phone:212-305-3535
Mailing Address - Fax:212-342-1470
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3735
Practice Address - Country:US
Practice Address - Phone:212-305-3535
Practice Address - Fax:212-342-1470
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2014-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY253342208100000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXVTR1Medicare PIN