Organization
CRYSTAL MEDICAL CARE,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISHWANATH VALAGEREHALLY PUTTASWAMYGOWDA M.D., (PRESIDENT)
(718) 803-6300
Entity
Organization
Contact information
Practice address
6914 41ST AVE, STE C1, WOODSIDE, NY 11377-4028
(718) 803-6300
(718) 803-2434
Mailing address
6914 41ST AVE, STE C1, WOODSIDE, NY 11377-4028
(718) 803-6300
(718) 803-2434
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
223041
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03260455
—
NY
Enumeration date
03/03/2011
Last updated
04/25/2017
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