Healthcare Provider Details

I. General information

NPI: 1306757000
Provider Name (Legal Business Name): CROWNE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD STE 11
EMERSON NJ
07630-1368
US

IV. Provider business mailing address

466 OLD HOOK RD STE 11
EMERSON NJ
07630-1368
US

V. Phone/Fax

Practice location:
  • Phone: 786-626-0517
  • Fax:
Mailing address:
  • Phone: 786-626-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: XELENIA DEPENA
Title or Position: OWNER
Credential: MD
Phone: 786-626-0517