Provider Demographics
NPI:1154529568
Name:CROSSROADS MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:CROSSROADS MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUCERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-822-1377
Mailing Address - Street 1:518 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5733
Mailing Address - Country:US
Mailing Address - Phone:516-822-1377
Mailing Address - Fax:516-822-9794
Practice Address - Street 1:518 PLAINVIEW RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5733
Practice Address - Country:US
Practice Address - Phone:516-822-1377
Practice Address - Fax:516-822-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFW471Medicare ID - Type Unspecified