Healthcare Provider Details

I. General information

NPI: 1285731273
Provider Name (Legal Business Name): ROBERT M. CRISTAL PH.D.
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

37 SHELTER LN
ROSLYN HEIGHTS NY
11577-2524
US

IV. Provider business mailing address

37 SHELTER LN
ROSLYN HEIGHTS NY
11577-2524
US

V. Phone/Fax

Practice location:
  • Phone: 516-621-3339
  • Fax: 516-626-0457
Mailing address:
  • Phone: 516-621-3339
  • Fax: 516-626-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005576-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: