Healthcare Provider Details

I. General information

NPI: 1366540049
Provider Name (Legal Business Name): ROBERT CRYSTAL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 RIVER RD
POINT PLEASANT BORO NJ
08742-2163
US

IV. Provider business mailing address

3104 RIVER RD
POINT PLEASANT BORO NJ
08742-2163
US

V. Phone/Fax

Practice location:
  • Phone: 732-899-7242
  • Fax: 732-899-7242
Mailing address:
  • Phone: 732-899-7242
  • Fax: 732-899-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00350900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: