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Individual

CRYSTAL MADERA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8527 58TH AVE APT 2, ELMHURST, NY 11373-4811
(347) 846-8326
Mailing address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(718) 762-7633
(718) 886-8694

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
JLJ003837567
NY
Enumeration date
01/25/2018
Last updated
01/25/2018
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