Active NPI
Alexander Crystal, M.D
- Student in an Organized Health Care Education/Training Program
- Bridgeport, CT
National Provider Identifier
1376808048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- AB350126936
- Practice address
- 267 Grant St
Department of Internal Medicine
Bridgeport, CT 06610-2805 - Phone
- (203) 384-3792
- NPI assigned
- Jul 9, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | AB350126936 | CT | |
| Student in an Organized Health Care Education/Training Program | 390200000X | AB350126936 | CT | Primary |
Addresses
Primary practice location
267 Grant St
Department of Internal Medicine
Bridgeport, CT 06610-2805
Mailing address
267 Grant St
Bridgeport, CT 06610-2805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AB350126936 | CT | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1376808048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "267 GRANT ST",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066102805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "267 GRANT ST",
"address_2": "DEPARTMENT OF INTERNAL MEDICINE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066102805",
"telephone_number": "203-384-3792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRYSTAL",
"first_name": "ALEXANDER",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-09",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "AB350126936",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CT",
"license": "AB350126936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.