Individual
CRYSTAL BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
509 WILLIS AVENUE, BRONX, NY 10455
(347) 571-2179
Mailing address
509 WILLIS AVENUE, BRONX, NY 10455
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171M00000X
MEDICAID SERVICE COORDINATOR
NY
Enumeration date
07/20/2012
Last updated
07/20/2012
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