Organization
CROWN OF LIFE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY ANGLIN (SOLE PROPRIETOR)
(718) 526-8921
Entity
Organization
Contact information
Practice address
14644 LAKEWOOD AVE, JAMAICA, NY 11435-5438
(718) 526-8921
Mailing address
14644 LAKEWOOD AVE, JAMAICA, NY 11435-5438
(718) 526-8921
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1180L001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02177580
—
NY
05
—
02335106
—
NY
05
—
02431905
—
NY
05
—
02433654
—
NY
Enumeration date
01/29/2007
Last updated
08/22/2020
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