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Individual

PROF. KRYSTLE CHALICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
JD

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
906369002
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
BF40661J-00
NY
01
DBF40661J
CDPHP - MCO
NY
01
S2012
CONSOLIDATED HEALTH PLAN MAGNACARE
Enumeration date
05/31/2022
Last updated
07/12/2026
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