MEDICARE: CRYSTAL LEAKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46TR00866100	OTHER	NJ	SENSORY GYM

General Provider Information

NPI Number	:	1144934621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LEAKE

Provider Business Mailing Address
First Line	:	16 ROYAL AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 ROYAL AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3122
Country	:	US
Telephone Number	:	973-207-3117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

Similar Medicare Providers

1497558084 — EDWIGE DOSSOU-KITTI
Practice Location Address:

2110 TOWN CENTER WAY # 1079
LIVINGSTON, NJ
07039-2978

Practice Phone: 516-495-3298
Practice Fax:

1497191423 — MATTHEW J HANLON M.D.
Practice Location Address:

94 OLD SHORT HILLS RD
LIVINGSTON, NJ
07039-5672

Practice Phone: 973-322-9801
Practice Fax:

1679576045 — DR. SEKHAR GOPALAN IYER MD, DO
Practice Location Address:

94 OLD SHORT HILLS RD RM 4225
LIVINGSTON, NJ
07039-5672

Practice Phone: 973-322-5777
Practice Fax:

1508545906 — JOY SAAH LPC
Practice Location Address:

315 E NORTHFIELD RD
LIVINGSTON, NJ
07039-4896

Practice Phone: 908-228-2740
Practice Fax:

1376476176 — STEPHANIE BUSH
Practice Location Address:

94 OLD SHORT HILLS RD
LIVINGSTON, NJ
07039-5672

Practice Phone: 973-322-2846
Practice Fax:

1730474503 — DR. JORDAN LEVY PH.D.
Practice Location Address:

66 W MOUNT PLEASANT AVE STE 206
LIVINGSTON, NJ
07039-2930

Practice Phone: 973-251-2228
Practice Fax:

Directions to “ CRYSTAL LEAKE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.