1053856138 NPI number — CRYSTAL AMOAH

Table of content: CRYSTAL AMOAH (NPI 1053856138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053856138 NPI number — CRYSTAL AMOAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMOAH
Provider First Name:
CRYSTAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053856138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 E JONATHAN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQ
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-620-5677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 CAPITOL TRAIL
Provider Second Line Business Practice Location Address:
BUILDING 3
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-454-7520
Provider Business Practice Location Address Fax Number:
302-565-6049
Provider Enumeration Date:
12/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  SP017077 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: L8-0000174 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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