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General NPI Number Information
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NPI Number | 1619512902
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Entity Type | Individual
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Provider Name | CRYSTALENE JOY F MARCHUT
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Gender | Female
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 101 WHIPPANY RD
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City | WHIPPANY
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State | NJ
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Zip | 07981-1407
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Country | US
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Telephone | 973-599-9134
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Fax |
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Provider Business Mailing Address
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Address Line | 59 FALMOUTH AVE
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1643
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Country | US
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Telephone | 845-499-9134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 46TA09127400
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License Number State | NJ
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