NPIMap

Organization Active NPI

Crystal Ray Medical P.C.

  • Neurology Physician
  • Rego Park, NY
National Provider Identifier
1881819308
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
CRYSTAL RAY MEDICAL P.C.
Practice address
9614 63Rd Dr
Suite 200
Rego Park, NY 11374-2239
Phone
(718) 896-0111
Fax
(718) 896-2161
NPI assigned
Apr 17, 2007
Last updated
Apr 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Marina Adelman
Title
Billing Department
Phone
(718) 743-7090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

9614 63Rd Dr
Suite 200
Rego Park, NY 11374-2239

Mailing address

9614 63Rd Dr
Suite 200
Rego Park, NY 11374-2239
Phone (718) 896-0111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070521000392 NY Part B Supplier - Clinic/Group Practice 0648377986 Receives reassigned benefits from 2 practitioners
Practice locations: Rego Park, NY

National Provider Directory

National Provider Directory

Locations

9614 63rd Dr
Ste 200
Rego Park, NY 11374
Phone (718) 896-0111

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1881819308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9614 63RD DR",
            "address_2": "SUITE 200",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742239",
            "telephone_number": "718-896-0111",
            "fax_number": "718-896-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9614 63RD DR",
            "address_2": "SUITE 200",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742239",
            "telephone_number": "718-896-0111",
            "fax_number": "718-896-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL RAY MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "ADELMAN",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "BILLING DEPARTMENT",
        "authorized_official_telephone_number": "718-743-7090"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.