Provider Demographics
NPI:1265415947
Name:CRISPINO, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CRISPINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:CRISPINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:250 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3636
Mailing Address - Country:US
Mailing Address - Phone:718-966-6175
Mailing Address - Fax:718-966-1594
Practice Address - Street 1:4665 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4152
Practice Address - Country:US
Practice Address - Phone:718-356-9826
Practice Address - Fax:718-966-1594
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003913213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480033373OtherRR MEDICARE
NY0008386OtherGHI
NYA400042574Medicare PIN
NY480033373OtherRR MEDICARE