Provider Demographics
NPI:1043498447
Name:ROBERT L. CRISTOFARO, MD AND JOHN M NELSON, MD,PC
Entity type:Organization
Organization Name:ROBERT L. CRISTOFARO, MD AND JOHN M NELSON, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CRISTOFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-967-8708
Mailing Address - Street 1:3010 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2524
Mailing Address - Country:US
Mailing Address - Phone:914-967-8708
Mailing Address - Fax:914-967-5834
Practice Address - Street 1:3010 WESTCHESTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2524
Practice Address - Country:US
Practice Address - Phone:914-967-8708
Practice Address - Fax:914-967-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112796174400000X, 207X00000X, 207XP3100X
NY150073174400000X, 207X00000X, 207XP3100X
CT028526207XP3100X
CT028357207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347411Medicaid
NY00970338Medicaid
A62671Medicare UPIN
A63905Medicare UPIN