Individual
CRYSTAL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
997 SHELBURNE DR, FRANKLIN SQUARE, NY 11010-1011
(631) 265-5300
Mailing address
14645 182ND ST, SPRINGFIELD GARDENS, NY 11413-3734
(347) 569-1692
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
331320
NY
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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