Provider Demographics
NPI:1740234343
Name:CRYSTAL CLEAR DIAGNOSTICS SERVICES INC
Entity Type:Organization
Organization Name:CRYSTAL CLEAR DIAGNOSTICS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-330-3562
Mailing Address - Street 1:2601 BELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-280-0455
Mailing Address - Fax:732-280-0453
Practice Address - Street 1:2601 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-280-0455
Practice Address - Fax:732-280-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY59023555335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101113Medicare PIN
PA118876Medicare PIN
NJ31X0009839Medicare PIN
NY02W751Medicare ID - Type UnspecifiedPORTABLE XRAY