Provider Demographics
NPI:1891880563
Name:CRISTOFANILLI, MASSIMO (MD)
Entity Type:Individual
Prefix:
First Name:MASSIMO
Middle Name:
Last Name:CRISTOFANILLI
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 1:420 E 70TH ST # LH203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5320
Mailing Address - Country:US
Mailing Address - Phone:164-696-2594
Mailing Address - Fax:
Practice Address - Street 1:528 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6302
Practice Address - Country:US
Practice Address - Phone:646-962-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.100606207RX0202X
NY314815207RH0003X
IL036139231174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA178130Medicare PIN
G84800Medicare UPIN
85731JMedicare ID - Type Unspecified
NJ0227234Medicaid
PA102448545Medicaid
TX44013301Medicaid