Healthcare Provider Details

I. General information

NPI: 1770130304
Provider Name (Legal Business Name): KRYSTAL CROMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243A WOODHAVEN BLVD
REGO PAEK NY
10310-1552
US

IV. Provider business mailing address

331 DAVIS AVE
STATEN ISLAND NY
10310-1552
US

V. Phone/Fax

Practice location:
  • Phone: 347-414-2936
  • Fax:
Mailing address:
  • Phone: 347-414-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: