Provider Demographics
NPI:1730422981
Name:MCCRISTALL, MICHAEL (ATC, NSCA-CPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MCCRISTALL
Suffix:
Gender:M
Credentials:ATC, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S PLAISTED AVE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2754
Mailing Address - Country:US
Mailing Address - Phone:631-889-0303
Mailing Address - Fax:
Practice Address - Street 1:3272 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1345
Practice Address - Country:US
Practice Address - Phone:516-731-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0019152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer