Provider Demographics
NPI:1730146051
Name:CRISAN, LIVIU C (MD)
Entity Type:Individual
Prefix:DR
First Name:LIVIU
Middle Name:C
Last Name:CRISAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-242-4322
Mailing Address - Fax:609-242-4324
Practice Address - Street 1:651 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731
Practice Address - Country:US
Practice Address - Phone:609-242-4322
Practice Address - Fax:609-242-4324
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J9788OtherHORIZON
P488102OtherOXFORD
J9788OtherHORIZON
F98298Medicare UPIN