Healthcare Provider Details

I. General information

NPI: 1548443021
Provider Name (Legal Business Name): CAJ III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE SUITE 1906
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE SUITE 1906
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-6770
  • Fax:
Mailing address:
  • Phone: 212-752-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberXO008088
License Number StateNY

VIII. Authorized Official

Name: DR. CRYSTAL A JOSEPH
Title or Position: APPLIED KINESIOLOGIST
Credential: D.C., AK, CCSP
Phone: 212-752-6770