TIMOTHY J CRISCUOLO (NPI# 1881613032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881613032 |
| Entity Type | Individual |
| Full Name | TIMOTHY J CRISCUOLO |
| Credential | PA-C |
| Practice Address |
71 W 156th St Ste 309 Harvey IL 60426-4264 |
| Mailing Address |
150 Harvester Dr Ste 300 Burr Ridge IL 60527-5965 |
| Practice Telephone | 7737021061 |
| Mailing Telephone | 7737021061 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-02-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085006618 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0110002020 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | PHYSICIAN ASST LICENSE | 0110002020 | 01 |
| VA | 1881613032 | 05 | |
| DEA REGISTRATION | MC0808040 | 01 |
| Street Address |
71 W 156TH ST STE 309 |
| City | HARVEY |
| State | IL |
| Zip Code | 60426-4264 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295377471 | Carol E Gillett | Technician | 14607 Jefferson St., Harvey, IL 60426 | 2019-10-09 |
| 1356866479 | Zzm Investments Inc | Non-emergency Medical Transport (VAN) | 16429 Halsted St, Harvey, IL 60426 | 2017-08-09 |
| 1639628225 | Scottlab, Ltd. | Clinical Medical Laboratory | 71 W 156th St Ste 206a, Harvey, IL 60426 | 2016-09-24 |
| 1043608631 | Yvette M. Johnson | Nurse Practitioner | 31 W. 155th Street, Harvey, IL 60426 | 2015-01-05 |
| 1558665539 | Phillip T Robinson | Contractor | 16001 Marshfield St, Harvey, IL 60426 | 2011-01-05 |
| 1669657466 | South Shore Behavioral Consultants | Counselor | 369 East 147th Street Suite E, Harvey, IL 60426 | 2007-12-31 |
| 1770784670 | County of Cook Harvey Public School District 152 | Local Education Agency (LEA) | 152nd Myrtle St, Harvey, IL 60426 | 2007-05-29 |
| 1518180678 | Associated Medical Center Sc | Family Medicine | 15900 So Carol Avenue, Harvey, IL 60426 | 2007-04-10 |
| 1336269133 | Cook County | Clinic/Center | 650 E Phoenix Center Dr, Phoenix, IL 60426 | 2007-03-29 |
| 1932243433 | Michael T Jones Dmd Ltd | Dentist | 15335 Page Ave, Harvey, IL 60426 | 2007-02-16 |
| Find all providers in zip 60426 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972010718 | Lindsay Syring | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2018-01-02 |
| 1154848943 | Stephanie Ann Caja | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426 | 2017-08-23 |
| 1134672116 | Nicole Gentry | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2016-07-26 |
| 1831582055 | Fatema Ukani | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2015-03-12 |
| 1811148059 | Viquar U Ahmed | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2008-10-07 |
| 1376753319 | Melissa Okeefe | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2007-05-22 |
| 1043348717 | Larry L Foster | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2007-03-02 |
| 1518093483 | Jennifer A Deneen | Physician Assistant | 1 Ingalls Dr, Harvey, IL 60426-3558 | 2007-02-26 |
| 1114095064 | Julie Ann Keller | Physician Assistant | 922 Lincoln Ave, Harvey, ND 58341-1524 | 2006-11-30 |
| 1508962838 | Peggy P Demikis | Physician Assistant | One Ingalls Dr, W536, Harvey, IL 60426 | 2006-09-15 |
| Find all providers in HARVEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.