Provider Demographics
NPI:1548330343
Name:ACUTE INJURY AND ILLNESS CENTERS LLC
Entity type:Organization
Organization Name:ACUTE INJURY AND ILLNESS CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRISANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-213-0119
Mailing Address - Street 1:12547 OCEAN GATEWAY
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9341
Mailing Address - Country:US
Mailing Address - Phone:410-213-0119
Mailing Address - Fax:410-213-2875
Practice Address - Street 1:12547 OCEAN GATEWAY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9341
Practice Address - Country:US
Practice Address - Phone:410-213-0119
Practice Address - Fax:410-213-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050255207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0050255OtherLICENSE NUMBER
MDD0050255OtherLICENSE NUMBER
MDD0050255OtherLICENSE NUMBER