Provider Demographics
NPI:1083829840
Name:CRYSTAL, RAYMOND FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FREDERICK
Last Name:CRYSTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 LONG HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1530
Mailing Address - Country:US
Mailing Address - Phone:973-467-2419
Mailing Address - Fax:973-467-8439
Practice Address - Street 1:325 LONG HILL DR
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1530
Practice Address - Country:US
Practice Address - Phone:973-467-2419
Practice Address - Fax:973-467-8439
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02459400208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery