Individual
CRYSTAL TANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
311 BAY AVE, MMG INTERNAL MED, GLEN RIDGE, NJ 07028
(973) 748-9246
(973) 748-8755
Mailing address
PO BOX 419430, BOSTON, MA 02241-9430
(201) 967-8221
(201) 483-2242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA10421000
NJ
Other
Enumeration date
04/14/2014
Last updated
02/17/2020
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