Basic Information
Provider Information | |||||||||
NPI: | 1265723027 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAGASPI | ||||||||
FirstName: | CRISCHELLE | ||||||||
MiddleName: | VILBAR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 N END AVE APT 22E | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 102827018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3478217794 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | MARY IMOGENE BASSETT MEDICAL CENTER | ||||||||
Address2: | 1 ATWELL ROAD | ||||||||
City: | COOPERSTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 13326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6075473283 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2011 | ||||||||
LastUpdateDate: | 01/28/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 283258-1 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0200X | 04-40999 | KS | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 283258-1 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 283258 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 390200000X |   | NY | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RP1001X | 01081554A | IN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 207RP1001X | 01 | NY | TAXONOMY NUMBER | OTHER | 283258 | 05 | NY |   | MEDICAID | 1326550001 | 01 | NY | TAXONOMY NUMBER | OTHER | 207RP1001X | 05 | NY |   | MEDICAID |