Provider Demographics
NPI:1710506456
Name:CRESWELL, JOSEPH ALEXANDER (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:CRESWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 VESTAL PKWY E FL 2
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3556
Mailing Address - Country:US
Mailing Address - Phone:607-772-8772
Mailing Address - Fax:
Practice Address - Street 1:4433 VESTAL PKWY E FL 2
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-772-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPR00214213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist