Provider Demographics
NPI:1104925684
Name:CRINCOLI, MARIA (DC)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CRINCOLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1710
Mailing Address - Country:US
Mailing Address - Phone:973-376-2888
Mailing Address - Fax:973-376-3939
Practice Address - Street 1:258 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1710
Practice Address - Country:US
Practice Address - Phone:973-376-2888
Practice Address - Fax:973-376-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454392Medicare ID - Type UnspecifiedMEDICARE
NJT45398Medicare UPIN