Provider Demographics
NPI:1336226240
Name:KRYSTAL, JOHN HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARRISON
Last Name:KRYSTAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:119 MAPLEVALE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1142
Mailing Address - Country:US
Mailing Address - Phone:203-393-2604
Mailing Address - Fax:203-393-1086
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:151D
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-937-4790
Practice Address - Fax:203-937-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0274732084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry