Healthcare Provider Details

I. General information

NPI: 1538023981
Provider Name (Legal Business Name): CRYSTAL FENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 NOB HILL DR
ELMSFORD NY
10523-2432
US

IV. Provider business mailing address

263 NOB HILL DR
ELMSFORD NY
10523-2432
US

V. Phone/Fax

Practice location:
  • Phone: 718-913-9948
  • Fax:
Mailing address:
  • Phone: 718-913-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: