Provider Demographics
NPI:1609995323
Name:CRESCITELLI, SALVATORE (LPN)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:CRESCITELLI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1948
Mailing Address - Country:US
Mailing Address - Phone:845-292-0802
Mailing Address - Fax:
Practice Address - Street 1:2 GREEN LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1948
Practice Address - Country:US
Practice Address - Phone:845-292-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157367-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse