Provider Demographics
NPI:1326767500
Name:CROWN & GLORY LLC
Entity Type:Organization
Organization Name:CROWN & GLORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:CHLS
Authorized Official - Phone:201-487-4100
Mailing Address - Street 1:209 CLINTON PL
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3686
Mailing Address - Country:US
Mailing Address - Phone:201-487-4100
Mailing Address - Fax:
Practice Address - Street 1:209 CLINTON PL
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3686
Practice Address - Country:US
Practice Address - Phone:201-487-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN & GLORY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier