Provider Demographics
NPI:1881819308
Name:CRYSTAL RAY MEDICAL P.C.
Entity Type:Organization
Organization Name:CRYSTAL RAY MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:9614 63RD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2239
Mailing Address - Country:US
Mailing Address - Phone:718-896-0111
Mailing Address - Fax:718-896-2161
Practice Address - Street 1:9614 63RD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2239
Practice Address - Country:US
Practice Address - Phone:718-896-0111
Practice Address - Fax:718-896-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH33857Medicare UPIN