Provider Demographics
NPI:1609093137
Name:CRESPO, PATRICIA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIA
Last Name:CRESPO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W 190TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3653
Mailing Address - Country:US
Mailing Address - Phone:917-359-7702
Mailing Address - Fax:347-767-7714
Practice Address - Street 1:4290 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3732
Practice Address - Country:US
Practice Address - Phone:212-927-4315
Practice Address - Fax:347-767-7714
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0526611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711993Medicaid