Healthcare Provider Details

I. General information

NPI: 1619906914
Provider Name (Legal Business Name): CRYSTAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 EMBASSY PKWY
AKRON OH
44333-8320
US

IV. Provider business mailing address

3975 EMBASSY PKWY
AKRON OH
44333-8320
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4040
  • Fax:
Mailing address:
  • Phone: 330-668-4040
  • Fax: 330-666-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J FERRY
Title or Position: CEO
Credential:
Phone: 330-668-4152