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General NPI Number Information
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NPI Number | 1508002445
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Entity Type | Organization
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Legal Business Name | 133 EAST MEDICAL PC
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Dates
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Enumeration Date | 12/24/2008
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 252 E 61ST ST APT 1DN
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City | NEW YORK
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State | NY
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Zip | 10065-8559
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-0270
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY STEPHEN CRESPIN
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Credential | MD
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Telephone | 917-721-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 60247944
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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