Provider Demographics
NPI:1154627982
Name:CRYSTAL DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:CRYSTAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-998-9777
Mailing Address - Street 1:39555 ORCHARD HILL PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39555 ORCHARD HILL PL
Practice Address - Street 2:SUITE 600
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5374
Practice Address - Country:US
Practice Address - Phone:800-998-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty