Provider Demographics
NPI:1316029424
Name:CRISCUOLO, RALPH ANTHONY (DC CC SP)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANTHONY
Last Name:CRISCUOLO
Suffix:
Gender:M
Credentials:DC CC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2301
Mailing Address - Country:US
Mailing Address - Phone:203-234-7989
Mailing Address - Fax:203-234-7516
Practice Address - Street 1:18 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2301
Practice Address - Country:US
Practice Address - Phone:203-234-7989
Practice Address - Fax:203-234-7516
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V9705OtherHEALTHNET INS
CTP3641945OtherOXFORD HEALTH INSURANCE
CT050000911CT02OtherBLUE CROSS INS