Provider Demographics
NPI:1194107433
Name:DECRISTOFARO, CRAIG A
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:DECRISTOFARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3249
Mailing Address - Country:US
Mailing Address - Phone:516-729-9885
Mailing Address - Fax:
Practice Address - Street 1:212 BELAIR DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3249
Practice Address - Country:US
Practice Address - Phone:516-729-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist