Provider Demographics
NPI:1629244348
Name:S J CONTRISTANO MD PC
Entity Type:Organization
Organization Name:S J CONTRISTANO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONTRISTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-252-4414
Mailing Address - Street 1:1520 YORK AVE
Mailing Address - Street 2:APT. 31D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7008
Mailing Address - Country:US
Mailing Address - Phone:718-252-4414
Mailing Address - Fax:718-377-1850
Practice Address - Street 1:2462 FLATBUSH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5000
Practice Address - Country:US
Practice Address - Phone:718-252-4414
Practice Address - Fax:718-377-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00170154Medicaid
NY00170154Medicaid