Organization
CRYSTALLENSEXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIR KHAIRY (MANAGER)
(201) 865-8300
Entity
Organization
Contact information
Practice address
3907 BERGENLINE AVE, UNION CITY, NJ 07087-4819
(201) 865-8300
(201) 865-5549
Mailing address
3907 BERGENLINE AVE., UNION CITY, NJ 07087-4750
(201) 865-8300
(201) 865-5549
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
31TD003514
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31TD00351400
LINCESE
NJ
Enumeration date
02/27/2007
Last updated
09/02/2016
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