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General NPI Number Information
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NPI Number | 1619762853
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Entity Type | Individual
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Provider Name | CRYSTAL ANN GODFREY AGNPPC-BC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 110 E 59TH ST RM 8A
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City | NEW YORK
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State | NY
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Zip | 10022-1864
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Country | US
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Telephone | 212-434-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 333 BRONX RIVER RD APT 516
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City | YONKERS
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State | NY
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Zip | 10704-3449
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Country | US
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Telephone | 845-521-6711
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F312166
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F312166
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License Number State | NY
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