Provider Demographics
NPI:1194816348
Name:BARTEL R. CRISAFI, MD
Entity type:Organization
Organization Name:BARTEL R. CRISAFI, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRISAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-869-5515
Mailing Address - Street 1:35 RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2717
Mailing Address - Country:US
Mailing Address - Phone:203-869-5515
Mailing Address - Fax:203-869-5765
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2717
Practice Address - Country:US
Practice Address - Phone:203-869-5515
Practice Address - Fax:203-869-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11889207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00258Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER