Individual
CRYSTAL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(914) 582-3086
Mailing address
PO BOX 546, CROMPOND, NY 10517-0546
(914) 582-3086
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
736283-1
NY
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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