# CRYSTALLENSEXPRESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851428825
- **Authorized official:** AMIR KHAIRY (MANAGER)
- **Authorized official phone:** (201) 865-8300

## Contact information

- **Practice address:** 3907 BERGENLINE AVE, UNION CITY, NJ 07087-4819
- **Practice address phone:** (201) 865-8300
- **Practice address fax:** (201) 865-5549
- **Mailing address:** 3907 BERGENLINE AVE., UNION CITY, NJ 07087-4750
- **Mailing address phone:** (201) 865-8300
- **Mailing address fax:** (201) 865-5549

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 31TD003514 | NJ | Yes |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 09/02/2016