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General NPI Number Information
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NPI Number | 1801362801
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Entity Type | Organization
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Legal Business Name | CRYSTAL RUN HEALTHCARE PHYSICIANS LLP
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 155 CRYSTAL RUN RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4028
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Country | US
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Telephone | 845-703-6179
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Fax | 845-796-5803
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Provider Business Mailing Address
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Address Line | 155 CRYSTAL RUN RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4028
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Country | US
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Telephone | 845-703-6179
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Fax | 845-796-5803
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | THERESA DOLSON
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Credential | PHARMD
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Telephone | 917-414-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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