Provider Demographics
NPI:1992018360
Name:FLAVIO CRISARI PHYSICIAN PC
Entity Type:Organization
Organization Name:FLAVIO CRISARI PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-441-3970
Mailing Address - Street 1:8533 FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1130
Mailing Address - Country:US
Mailing Address - Phone:718-441-3970
Mailing Address - Fax:718-441-6291
Practice Address - Street 1:8533 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1130
Practice Address - Country:US
Practice Address - Phone:718-441-3970
Practice Address - Fax:718-441-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY172573OtherLICENSE NUMBER
NY01045298Medicaid
NYG100034859Medicare PIN
NY172573OtherLICENSE NUMBER
NYG400034860Medicare PIN