Provider Demographics
NPI:1386742039
Name:CRISS, ADAM (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CRISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1017
Mailing Address - Country:US
Mailing Address - Phone:516-775-4545
Mailing Address - Fax:516-775-4646
Practice Address - Street 1:1999 MARCUS AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1017
Practice Address - Country:US
Practice Address - Phone:516-775-4545
Practice Address - Fax:516-775-4646
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY216967207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY059AA1Medicare PIN
NYH62396Medicare UPIN