Provider Demographics
NPI:1538610522
Name:CREST MEDICAL CARE, PC
Entity type:Organization
Organization Name:CREST MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WU
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-341-0365
Mailing Address - Street 1:13336 41ST RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3666
Mailing Address - Country:US
Mailing Address - Phone:347-341-0365
Mailing Address - Fax:718-886-0644
Practice Address - Street 1:2520 146TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1329
Practice Address - Country:US
Practice Address - Phone:347-341-0365
Practice Address - Fax:718-886-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267436-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty