Provider Demographics
NPI:1619762853
Name:GODFREY, CRYSTAL ANN (AGNPPC-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:GODFREY
Suffix:
Gender:F
Credentials:AGNPPC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BRONX RIVER RD APT 516
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3449
Mailing Address - Country:US
Mailing Address - Phone:845-521-6711
Mailing Address - Fax:
Practice Address - Street 1:110 E 59TH ST RM 8A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1864
Practice Address - Country:US
Practice Address - Phone:212-434-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF312166363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology