Healthcare Provider Details

I. General information

NPI: 1841995925
Provider Name (Legal Business Name): CHRYSTAL ELISE RIJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ACORN TER
NEW CITY NY
10956-5901
US

IV. Provider business mailing address

3 ACORN TER
NEW CITY NY
10956-5901
US

V. Phone/Fax

Practice location:
  • Phone: 845-270-1862
  • Fax:
Mailing address:
  • Phone: 845-270-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01460800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: