| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CRYSTAL ST. FORT | 1871341073 | 2024-05-11 |
Crystal St. Fort is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1871341073. Registration indicates Crystal St. Fort is a provider of services with a specialization in Allopathic & Osteopathic Physicians, Dermatology (Dermatology: Procedural Dermatology, ) (Dermatology Procedural Dermatology, Allopathic & Osteopathic Physicians) (Dermatology, )
| Entity Type | Individual |
| Provider Name | Crystal St. Fort NP |
| Practice Office Address | 142 S 60TH ST UNIT A PHILADELPHIA, PA US |
| Practice Office Telephone | 2154955846 |
| Mailing Address | 142 S 60TH ST UNIT A PHILADELPHIA, PA 191393038 US |
| Business Telephone | 2154955846 |
| Code | Practice | License No State |
|---|---|---|
| 207NS0135X PRIMARY | Allopathic & Osteopathic Physicians Dermatology Dermatology: Procedural Dermatology Dermatology Procedural Dermatology Allopathic & Osteopathic Physicians Dermatology | SP029428
PA |
| 193400000X SING | Group Code |