Crystallensexpress

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

31TD003514 Issued in NJ

Legal business name

CRYSTALLENSEXPRESS

Practice address

3907 Bergenline Ave
Union City, NJ 07087-4819

Phone

(201) 865-8300

Fax

(201) 865-5549

NPI assigned

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amir Khairy

Title

Manager

Phone

(201) 865-8300

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1851428825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3907 BERGENLINE AVE.",
            "city": "UNION CITY",
            "state": "NJ",
            "postal_code": "070874750",
            "telephone_number": "201-865-8300",
            "fax_number": "201-865-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3907 BERGENLINE AVE",
            "city": "UNION CITY",
            "state": "NJ",
            "postal_code": "070874819",
            "telephone_number": "201-865-8300",
            "fax_number": "201-865-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTALLENSEXPRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "KHAIRY",
        "authorized_official_first_name": "AMIR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-865-8300"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NJ",
            "license": "31TD003514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LINCESE",
            "identifier": "31TD00351400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coxphit LLC
• Coxphit LLC
• Robert J Craig, DMD
• Diana C Cruz
• Nicole Cruz
• Melanie D'Souza
• Sarah Dade, AADP, IAHC, INHC
• Aurora Dalisay, APN,C
• Patricia Daly, LCSW
• Daniel J Dussman Dba Industrial Strength Fitness

• Health Maintenance Organization in Union City, NJ
• Providers in Union City, NJ by specialty
• Health Maintenance Organization in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.