MEDICARE: CRYSTAL VIEW SERVICES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	03221	NY

General Provider Information

NPI Number	:	1275774002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL VIEW SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 690277
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-0762
Country	:	US
Telephone Number	:	646-250-0875
Fax Number	:

Provider Business Practice Location Address
First Line	:	21455 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1733
Country	:	US
Telephone Number	:	646-250-0875
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAT LYNCH
Credential	:
Telephone Number	:	646-250-0875

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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