Provider Demographics
NPI:1770889990
Name:KRYSTAL, JONATHAN D (MD,)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:KRYSTAL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:444 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2460
Mailing Address - Country:US
Mailing Address - Phone:516-218-4729
Mailing Address - Fax:516-992-4637
Practice Address - Street 1:45 CROSSWAYS PARK DR W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2037
Practice Address - Country:US
Practice Address - Phone:516-218-4729
Practice Address - Fax:516-992-4637
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD454050207XS0117X
NJ25MA09706000207XS0117X
NY284472174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine