Individual
CRYSTAL CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
134-15 228TH STREET APT 1, LAURELTON, NY 11413
(516) 578-2944
Mailing address
134-15 228TH STREET APT 1, LAURELTON, NY 11413
(516) 578-2944
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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